Provider Demographics
NPI:1295898609
Name:YOUNG JR, ROBERT A (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:YOUNG JR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4906 BARDSTOWN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1759
Mailing Address - Country:US
Mailing Address - Phone:502-499-9770
Mailing Address - Fax:502-499-9796
Practice Address - Street 1:4906 BARDSTOWN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1759
Practice Address - Country:US
Practice Address - Phone:502-499-9770
Practice Address - Fax:502-499-9796
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60060373Medicaid
KY431515OtherUNITED CONCORDIA