Provider Demographics
NPI:1487816930
Name:YOUNG & YOUNG DENTAL
Entity type:Organization
Organization Name:YOUNG & YOUNG DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:YOUNG JR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-499-9770
Mailing Address - Street 1:4906 BARDSTOWN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40291-1759
Mailing Address - Country:US
Mailing Address - Phone:502-499-9770
Mailing Address - Fax:502-499-9796
Practice Address - Street 1:4906 BARDSTOWN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-1759
Practice Address - Country:US
Practice Address - Phone:502-499-9770
Practice Address - Fax:502-499-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60060373Medicaid