Provider Demographics
NPI:1285703884
Name:CHARLES E. YOUNG, JR, DDS
Entity type:Organization
Organization Name:CHARLES E. YOUNG, JR, DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:901-853-2520
Mailing Address - Street 1:624 W POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-2540
Mailing Address - Country:US
Mailing Address - Phone:901-853-2520
Mailing Address - Fax:901-854-9273
Practice Address - Street 1:624 W POPLAR AVE
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-2540
Practice Address - Country:US
Practice Address - Phone:901-853-2520
Practice Address - Fax:901-854-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000023041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty