Provider Demographics
NPI:1881184547
Name:YOUNG DENTAL GROUP, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:YOUNG DENTAL GROUP, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRYSTLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-532-3092
Mailing Address - Street 1:181 2ND AVE STE 575
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3838
Mailing Address - Country:US
Mailing Address - Phone:650-532-3092
Mailing Address - Fax:
Practice Address - Street 1:181 2ND AVE STE 575
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3838
Practice Address - Country:US
Practice Address - Phone:650-532-3092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty