Keith Young, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

DN15083 Issued in FL

Practice address

5381 N Socrum Loop Rd
Lakeland, FL 33809-4272

Phone

(863) 815-3313

Fax

(863) 816-8750

NPI assigned

Apr 30, 2008

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209513600000",
    "number": "1154597110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5381 N SOCRUM LOOP RD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338094272",
            "telephone_number": "863-815-3313",
            "fax_number": "863-816-8750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5381 N SOCRUM LOOP RD",
            "city": "LAKELAND",
            "state": "FL",
            "postal_code": "338094272",
            "telephone_number": "863-815-3313",
            "fax_number": "863-816-8750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-30",
        "last_updated": "2008-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN15083",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER LICENSE",
            "identifier": "Y520500541410",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Younetic LLC
• Durel G Young, AA
• Jill Allison Young, CNM
• Joseph N Young, M.D.
• Katie Young
• Keshayla Keandrea Young, APRN
• Patricia Ann Young, LMHC
• Skyler Nicole Young
• Syretta Young, LPN
• Sierra Frances Youngblood, M.S., CF-SLP

• Dentist in Lakeland, FL
• Providers in Lakeland, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.