Provider Demographics
NPI:1962237370
Name:YOUNG, ROSEANNE (RDH, OMT)
Entity type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RDH, OMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16685 E PHILLIPS LN
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4608
Mailing Address - Country:US
Mailing Address - Phone:801-360-9077
Mailing Address - Fax:
Practice Address - Street 1:16685 E PHILLIPS LN
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-4608
Practice Address - Country:US
Practice Address - Phone:801-360-9077
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002024641124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist