Provider Demographics
NPI:1770589616
Name:GRIGSBY-YOUNG, SHARI LARON (DDS)
Entity type:Individual
Prefix:DR
First Name:SHARI
Middle Name:LARON
Last Name:GRIGSBY-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 1:10922 S TRYON ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4151
Mailing Address - Country:US
Mailing Address - Phone:704-504-0999
Mailing Address - Fax:704-583-0092
Practice Address - Street 1:10922 S TRYON ST
Practice Address - Street 2:SUITE D
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4151
Practice Address - Country:US
Practice Address - Phone:704-504-0999
Practice Address - Fax:704-583-0092
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC902YVMedicaid