Provider Demographics
NPI:1871710376
Name:YOUNG, JOHN R (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 CENTRE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:MA
Mailing Address - Zip Code:02370-2610
Mailing Address - Country:US
Mailing Address - Phone:781-871-2772
Mailing Address - Fax:
Practice Address - Street 1:272 CENTRE AVE
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-2610
Practice Address - Country:US
Practice Address - Phone:781-871-2772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA130171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice