Provider Demographics
NPI:1124284104
Name:YOUNG, MATTHEW ORVAL (DDS)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ORVAL
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 MALETA LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7602
Mailing Address - Country:US
Mailing Address - Phone:303-660-8540
Mailing Address - Fax:
Practice Address - Street 1:718 MALETA LN
Practice Address - Street 2:SUITE 101
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7602
Practice Address - Country:US
Practice Address - Phone:303-660-8540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9908122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist