Provider Demographics
NPI:1184315103
Name:YOUNG, KELLY TAYLOR (RDH)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:TAYLOR
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-5511
Mailing Address - Country:US
Mailing Address - Phone:334-695-2850
Mailing Address - Fax:
Practice Address - Street 1:131 E BROAD ST
Practice Address - Street 2:
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-2023
Practice Address - Country:US
Practice Address - Phone:334-695-2850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALH.007134124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist