Provider Demographics
NPI:1740517580
Name:YOUNGMAN, KIRK (DMD)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:
Last Name:YOUNGMAN
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 1:8013 LAGUNA BLVD
Mailing Address - Street 2:STE #2
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7920
Mailing Address - Country:US
Mailing Address - Phone:916-350-0981
Mailing Address - Fax:916-691-6022
Practice Address - Street 1:8013 LAGUNA BLVD
Practice Address - Street 2:STE #2
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7920
Practice Address - Country:US
Practice Address - Phone:916-350-0981
Practice Address - Fax:916-691-6022
Is Sole Proprietor?:No
Enumeration Date:2009-11-16
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice