Provider Demographics
NPI:1952479230
Name:YOUNG, STEVEN RYAN (DMD, CAGS, PLLC)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RYAN
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DMD, CAGS, PLLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1702 S VAL VISTA DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-7304
Mailing Address - Country:US
Mailing Address - Phone:480-668-8200
Mailing Address - Fax:480-668-8202
Practice Address - Street 1:1702 S VAL VISTA DR STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-7304
Practice Address - Country:US
Practice Address - Phone:480-668-8200
Practice Address - Fax:480-668-8202
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ69681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics