Provider Demographics
NPI:1285717066
Name:YOUNG, LISA B (DDS)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:B
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 W SAMPLE RD
Mailing Address - Street 2:APARTMENT 103
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3248
Mailing Address - Country:US
Mailing Address - Phone:954-753-0878
Mailing Address - Fax:
Practice Address - Street 1:1035 SOUTH STATE ROAD 7
Practice Address - Street 2:SUITE 212
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-333-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN17516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist