Provider Demographics
NPI:1205077310
Name:KAY L. YOUNGGREN DDS
Entity type:Organization
Organization Name:KAY L. YOUNGGREN DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST./ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNGGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:575-746-1900
Mailing Address - Street 1:2520 W. HERMOSA DR.
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210
Mailing Address - Country:US
Mailing Address - Phone:575-746-1900
Mailing Address - Fax:575-748-2085
Practice Address - Street 1:2520 W. HERMOSA
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210
Practice Address - Country:US
Practice Address - Phone:575-746-1900
Practice Address - Fax:575-748-2085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD2755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty