Provider Demographics
NPI:1396973335
Name:YOUNG, JARED MATTHEW (DMD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:MATTHEW
Last Name:YOUNG
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 1:1930 NE 34TH CT
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-7520
Mailing Address - Country:US
Mailing Address - Phone:954-781-1855
Mailing Address - Fax:
Practice Address - Street 1:1930 NE 34TH CT
Practice Address - Street 2:
Practice Address - City:LIGHTHOUSE POINT
Practice Address - State:FL
Practice Address - Zip Code:33064-7520
Practice Address - Country:US
Practice Address - Phone:954-781-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020038122300000X
FLDN188011223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist