Provider Demographics
NPI:1881686285
Name:YOUNG, SAMUEL (DMD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31538 WHITEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6216
Mailing Address - Country:US
Mailing Address - Phone:951-760-2481
Mailing Address - Fax:
Practice Address - Street 1:31538 WHITEFIELD CT
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-6216
Practice Address - Country:US
Practice Address - Phone:951-760-2481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336951223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery