Provider Demographics
NPI:1760794754
Name:YOUNG, MICHAEL JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24883 ORO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8232
Mailing Address - Country:US
Mailing Address - Phone:310-795-8814
Mailing Address - Fax:
Practice Address - Street 1:24400 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORESTHILL
Practice Address - State:CA
Practice Address - Zip Code:95631-9334
Practice Address - Country:US
Practice Address - Phone:530-367-2250
Practice Address - Fax:530-367-4735
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25681122300000X
CA61210122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist