NPIMap

Organization Active NPI

Creekside Endodontics, a Young Dental Group, Inc.

  • Endodontics
  • Folsom, CA
National Provider Identifier
1588047120
Registry record updated Sep 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
58227 Issued in CA
Legal business name
CREEKSIDE ENDODONTICS, A YOUNG DENTAL GROUP, INC.
Practice address
2310 E. Bidwell St. #150
Folsom, CA 95630
Phone
(916) 983-7700
Fax
(916) 983-7981
NPI assigned
Jul 1, 2015
Last updated
Sep 8, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2023

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

Authorized official

Name
Dr. Eric William Young, DDS MMSC
Title
General Partner
Phone
(415) 513-2455

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223E0200X 56904 CA
EndodonticsGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223E0200X 58227 CA Primary

Addresses

Primary practice location

2310 E. Bidwell St. #150
Folsom, CA 95630

Mailing address

2310 E. Bidwell St. #150
Folsom, CA 95630
Phone (916) 983-7700

National Provider Directory

National Provider Directory

Locations

2310 E Bidwell St
Ste 150
Folsom, CA 95630
Phone (916) 983-7700

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1435708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694131200000",
    "number": "1588047120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2310 E. BIDWELL ST. #150",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "95630",
            "telephone_number": "916-983-7700",
            "fax_number": "916-983-7981"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2310 E. BIDWELL ST. #150",
            "city": "FOLSOM",
            "state": "CA",
            "postal_code": "95630",
            "telephone_number": "916-983-7700",
            "fax_number": "916-983-7981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE ENDODONTICS, A YOUNG DENTAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-01",
        "last_updated": "2023-09-08",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "GENERAL PARTNER",
        "authorized_official_telephone_number": "415-513-2455",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS MMSC"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "56904",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": "CA",
            "license": "58227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Folsom, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; 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.