Provider Demographics
NPI:1184932857
Name:YOUNG, NICHELLE MARIE (DENTAL ASSISTANT)
Entity type:Individual
Prefix:MRS
First Name:NICHELLE
Middle Name:MARIE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DENTAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 HOUNDS RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4079
Mailing Address - Country:US
Mailing Address - Phone:678-522-1363
Mailing Address - Fax:
Practice Address - Street 1:3635 BRASELTON HWY
Practice Address - Street 2:SUITE C
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1068
Practice Address - Country:US
Practice Address - Phone:678-714-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant