Provider Demographics
NPI:1760620322
Name:YOUNG, JOSEPH SPENCER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:SPENCER
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1855 CRANE RIDGE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4944
Mailing Address - Country:US
Mailing Address - Phone:601-982-8585
Mailing Address - Fax:601-981-2323
Practice Address - Street 1:1855 CRANE RIDGE DR
Practice Address - Street 2:SUITE B
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4944
Practice Address - Country:US
Practice Address - Phone:601-982-8585
Practice Address - Fax:601-981-2323
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPEDO 61-831223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry