Provider Demographics
NPI:1245915958
Name:YOUNG, KAITLIN ENGLISH (DMD)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:ENGLISH
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KAITLIN
Other - Middle Name:ELIZABETH
Other - Last Name:ENGLISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2491 NORWOOD DR SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-4630
Mailing Address - Country:US
Mailing Address - Phone:770-871-8328
Mailing Address - Fax:
Practice Address - Street 1:104 PROMINENCE POINT PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-1236
Practice Address - Country:US
Practice Address - Phone:770-704-6987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-20
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1230991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice