Active NPI
Winston Eugene Young, DDS
- Dentist
- Groton, CT
National Provider Identifier
1538636527
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 102963
- Practice address
- 1 Wahoo Ave
Groton, CT 06349-2324 - Phone
- (860) 694-4123
- NPI assigned
- Oct 27, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 102963 | CA | Primary |
Addresses
Primary practice location
1 Wahoo Ave
Groton, CT 06349-2324
Mailing address
55 South Rd Apt 7a
Groton, CT 06340-4639
Phone (510) 585-7035
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102963 | CA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540598400000",
"number": "1538636527",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 SOUTH RD APT 7A",
"city": "GROTON",
"state": "CT",
"postal_code": "063404639",
"telephone_number": "510-585-7035"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 WAHOO AVE",
"city": "GROTON",
"state": "CT",
"postal_code": "063492324",
"telephone_number": "860-694-4123"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "WINSTON",
"middle_name": "EUGENE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-10-27",
"last_updated": "2018-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "102963",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Groton, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.