Provider Demographics
NPI:1871185975
Name:COLIN YOUNG DMD INC
Entity Type:Organization
Organization Name:COLIN YOUNG DMD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:COLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-715-9343
Mailing Address - Street 1:842 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3526
Mailing Address - Country:US
Mailing Address - Phone:702-715-9343
Mailing Address - Fax:
Practice Address - Street 1:3028 W JACK LONDON BLVD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94551-7609
Practice Address - Country:US
Practice Address - Phone:925-905-9888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental