Provider Demographics
NPI:1841546736
Name:YOUNG, AUBREY (DMD)
Entity type:Individual
Prefix:DR
First Name:AUBREY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17235 N 75TH AVE STE A100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-0884
Mailing Address - Country:US
Mailing Address - Phone:623-825-6901
Mailing Address - Fax:623-825-9446
Practice Address - Street 1:17235 N 75TH AVE STE A100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-0884
Practice Address - Country:US
Practice Address - Phone:623-825-6901
Practice Address - Fax:623-825-9446
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV62971223G0001X
AZ9132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice