Provider Demographics
NPI:1649080037
Name:DEPEW AND YOUNG ORTHODONTICS, LLC
Entity type:Organization
Organization Name:DEPEW AND YOUNG ORTHODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORGANIZER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:DEPEW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:770-422-3939
Mailing Address - Street 1:2161 CEDARCREST RD
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-6404
Mailing Address - Country:US
Mailing Address - Phone:770-974-8255
Mailing Address - Fax:
Practice Address - Street 1:2161 CEDARCREST RD
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-6404
Practice Address - Country:US
Practice Address - Phone:770-974-8255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty