Provider Demographics
NPI:1154549798
Name:YOUNG, RICHARD ALEX (DENTIST)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALEX
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1887 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3463
Mailing Address - Country:US
Mailing Address - Phone:909-888-4482
Mailing Address - Fax:909-888-4156
Practice Address - Street 1:1887 BUSINESS CENTER DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3463
Practice Address - Country:US
Practice Address - Phone:909-888-4482
Practice Address - Fax:909-888-4156
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA342701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice