Provider Demographics
NPI:1669618195
Name:YOUNG, KATHRYN A (LD)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HARRINGTON RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:ME
Mailing Address - Zip Code:04573-3208
Mailing Address - Country:US
Mailing Address - Phone:207-563-3368
Mailing Address - Fax:866-336-7756
Practice Address - Street 1:748 MAIN ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4683
Practice Address - Country:US
Practice Address - Phone:207-563-3368
Practice Address - Fax:866-336-7756
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME5057122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist