Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D6601 | OR |
NPI | 1003026907 |
---|---|
Provider Name | Trenton Young |
First Address | Salem, OR 97304-3007 |
Second Address | Salem, OR 97304-3007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |