Provider Demographics
NPI:1124725635
Name:YOUNG, JAMIL BRIAN (DDS)
Entity type:Individual
Prefix:
First Name:JAMIL
Middle Name:BRIAN
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 1:1289 GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75603-6871
Mailing Address - Country:US
Mailing Address - Phone:903-931-2099
Mailing Address - Fax:
Practice Address - Street 1:10677 US 15 501 HWY STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387-5154
Practice Address - Country:US
Practice Address - Phone:910-295-5980
Practice Address - Fax:910-295-3593
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC136021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program