1801085063 NPI number — DR. CRAIG A YOUNG DMD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801085063 NPI number — DR. CRAIG A YOUNG DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
CRAIG
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801085063
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1055 RUTH ST.
Provider Second Line Business Mailing Address:
STE 2
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-775-8448
Provider Business Mailing Address Fax Number:
928-443-3278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1231 W. 9000 S.
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
WEST JORDAN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84088
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-999-4431
Provider Business Practice Location Address Fax Number:
801-878-7035
Provider Enumeration Date:
10/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  7399 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223X0400X , with the licence number: 5925457-9922 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1801085063 . This is a "ARIZONA NPI" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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