Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | DN 9025 | FL |
NPI | 1104948124 |
---|---|
Provider Name | Dr. Kirk Hicks Young |
First Address | Orange Park, FL 32073-4516 |
Second Address | Orange Park, FL 32073-4516 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2007 |
Last Update Date | 08/07/2007 |