Provider Demographics
NPI:1790792257
Name:YOUNG, ANNA L
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:L
Last Name:YOUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:410 SOUTH GLENDORA AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741-6207
Mailing Address - Country:US
Mailing Address - Phone:626-335-5114
Mailing Address - Fax:626-335-8566
Practice Address - Street 1:410 SOUTH GLENDORA AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-6207
Practice Address - Country:US
Practice Address - Phone:626-335-5114
Practice Address - Fax:626-335-8566
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice