Provider Demographics
NPI:1205870268
Name:YOUNG, MARK E (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
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:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:VT
Mailing Address - Zip Code:05055-0338
Mailing Address - Country:US
Mailing Address - Phone:802-295-5611
Mailing Address - Fax:
Practice Address - Street 1:205 BILLINGS FARM RD
Practice Address - Street 2:UNIT 1
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-5400
Practice Address - Country:US
Practice Address - Phone:802-295-5611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0160001211122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist