Provider Demographics
NPI:1790274124
Name:YOUNG, CORTNEY B (RDH)
Entity Type:Individual
Prefix:
First Name:CORTNEY
Middle Name:B
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WELLIVERS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:PA
Mailing Address - Zip Code:17814-8305
Mailing Address - Country:US
Mailing Address - Phone:570-394-4141
Mailing Address - Fax:
Practice Address - Street 1:36 WELLIVERS HILL RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:PA
Practice Address - Zip Code:17814-8305
Practice Address - Country:US
Practice Address - Phone:570-394-4141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH071720124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist