Provider Demographics
NPI:1528103355
Name:OWYOUNG, ANDREW (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:OWYOUNG
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 1:1108 CORPORATE WAY
Mailing Address - Street 2:STE 1
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-6118
Mailing Address - Country:US
Mailing Address - Phone:916-424-1703
Mailing Address - Fax:916-424-1724
Practice Address - Street 1:1108 CORPORATE WAY
Practice Address - Street 2:STE 1
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-6118
Practice Address - Country:US
Practice Address - Phone:916-424-1703
Practice Address - Fax:916-424-1724
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist