Provider Demographics
NPI:1184712366
Name:YOUNG, COREY ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:COREY
Middle Name:ANDREW
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 PARCHER RD
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820-9570
Mailing Address - Country:US
Mailing Address - Phone:419-562-5019
Mailing Address - Fax:419-468-0037
Practice Address - Street 1:1245 ST RT 598 SUITE B
Practice Address - Street 2:
Practice Address - City:GALION
Practice Address - State:OH
Practice Address - Zip Code:44833-1611
Practice Address - Country:US
Practice Address - Phone:419-468-2977
Practice Address - Fax:419-468-0037
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.020599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2171340Medicaid