Provider Demographics
NPI:1932210549
Name:POLITE-YOUNG, LORETTE (RPH,DDS)
Entity Type:Individual
Prefix:DR
First Name:LORETTE
Middle Name:
Last Name:POLITE-YOUNG
Suffix:
Gender:F
Credentials:RPH,DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23003 NORWALK LN
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29707-6301
Mailing Address - Country:US
Mailing Address - Phone:803-548-8377
Mailing Address - Fax:
Practice Address - Street 1:11010 S TRYON ST STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-0107
Practice Address - Country:US
Practice Address - Phone:704-587-7336
Practice Address - Fax:704-587-7579
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC77971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902YWMedicaid