Provider Demographics
NPI:1801085063
Name:YOUNG, CRAIG A (DMD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
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 1:1055 RUTH ST.
Mailing Address - Street 2:STE 2
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301
Mailing Address - Country:US
Mailing Address - Phone:928-775-8448
Mailing Address - Fax:928-443-3278
Practice Address - Street 1:1231 W. 9000 S.
Practice Address - Street 2:SUITE D
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088
Practice Address - Country:US
Practice Address - Phone:801-999-4431
Practice Address - Fax:801-878-7035
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ73991223X0400X
UT5925457-99221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1801085063OtherARIZONA NPI