Provider Demographics
NPI:1124758024
Name:YOUNG, RONALD GORDON (DMD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GORDON
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 WILLIAMS CT
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-1405
Mailing Address - Country:US
Mailing Address - Phone:251-377-6542
Mailing Address - Fax:
Practice Address - Street 1:5651 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-1617
Practice Address - Country:US
Practice Address - Phone:251-661-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD-0007070-C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist