Provider Demographics
NPI:1356579494
Name:YOUNG, ABBY RENEE' (DDS)
Entity type:Individual
Prefix:DR
First Name:ABBY
Middle Name:RENEE'
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 E ADMIRAL PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-8707
Mailing Address - Country:US
Mailing Address - Phone:405-762-2166
Mailing Address - Fax:
Practice Address - Street 1:6801 E ADMIRAL PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74115-8707
Practice Address - Country:US
Practice Address - Phone:405-762-2166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-27
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6125122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist