Provider Demographics
NPI:1427249887
Name:YOUNG, THOMAS (DDS)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
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 1:3529 HERITAGE TRACE PKWY STE 171
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4971
Mailing Address - Country:US
Mailing Address - Phone:817-741-4567
Mailing Address - Fax:817-741-4576
Practice Address - Street 1:3529 HERITAGE TRACE PKWY
Practice Address - Street 2:SUITE 171
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4970
Practice Address - Country:US
Practice Address - Phone:817-741-4567
Practice Address - Fax:817-741-4576
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX233211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX23321OtherDENTIST