Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 7821 | NC |
NPI | 1043321730 |
---|---|
Provider Name | Dr. Robert L Young JR. |
First Address | Fort Mill, SC 29715-6301 |
Second Address | Charlotte, NC 28211-1046 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |