Provider Demographics
NPI:1013440825
Name:YOUNG DENTAL, LTD
Entity Type:Organization
Organization Name:YOUNG DENTAL, LTD
Other - Org Name:MILL POND DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-536-4810
Mailing Address - Street 1:18700 WOLF RD
Mailing Address - Street 2:STE 200
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18700 WOLF RD
Practice Address - Street 2:STE 200
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8456
Practice Address - Country:US
Practice Address - Phone:954-536-4810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019029534261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental