Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 8740 | KY |
NPI | 1023249141 |
---|---|
Provider Name | Dr. Alexandra Mayes Young |
First Address | Florence, KY 41042-1906 |
Second Address | Frankfort, KY 40601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 11/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100098140 | (05) | KY |