Provider Demographics
NPI:1396074589
Name:YOUNG, JEANETTE M (DDS)
Entity type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:M
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 1:960 E PACES FERRY RD NE
Mailing Address - Street 2:APT 415
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1124
Mailing Address - Country:US
Mailing Address - Phone:202-870-2293
Mailing Address - Fax:
Practice Address - Street 1:2635 LEE RD
Practice Address - Street 2:SUITE C-4
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3356
Practice Address - Country:US
Practice Address - Phone:770-489-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-17
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60732122300000X
GADN014390122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist