Provider Demographics
NPI:1588753966
Name:YOUNG, TIMOTHY JERAMIAH (DDS)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JERAMIAH
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 1:13751 COUNTY ROAD 207
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-8831
Mailing Address - Country:US
Mailing Address - Phone:512-556-2380
Mailing Address - Fax:
Practice Address - Street 1:7401 LOHMANS FORD RD
Practice Address - Street 2:
Practice Address - City:LAGO VISTA
Practice Address - State:TX
Practice Address - Zip Code:78645-4758
Practice Address - Country:US
Practice Address - Phone:512-267-4163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16948OtherDENTAL LICENSE NUMBER