Provider Demographics
NPI:1982716403
Name:YOUNG, STEPHANIE R (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:R
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 910
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35056-0910
Mailing Address - Country:US
Mailing Address - Phone:256-739-3337
Mailing Address - Fax:256-739-3165
Practice Address - Street 1:506 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-4301
Practice Address - Country:US
Practice Address - Phone:256-739-3337
Practice Address - Fax:256-739-3165
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009936996Medicaid
AL009936996Medicaid