Provider Demographics
NPI:1942286885
Name:YOUNG, JEREMY M (DDS MMSC)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1364 WHISPERING PINES LANE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-272-4254
Mailing Address - Fax:530-272-3152
Practice Address - Street 1:1364 WHISPERING PINES LANE
Practice Address - Street 2:SUITE 2
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-272-4254
Practice Address - Fax:530-272-3152
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA49032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist