Provider Demographics
NPI:1023052842
Name:YOUNG, DAVID JEREMIAH (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JEREMIAH
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 ACKERMAN RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-3555
Mailing Address - Country:US
Mailing Address - Phone:937-298-7267
Mailing Address - Fax:937-298-0672
Practice Address - Street 1:3080 ACKERMAN RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-3555
Practice Address - Country:US
Practice Address - Phone:937-298-7267
Practice Address - Fax:937-298-0672
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30013394122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist