Active NPI
William Bruce Young, D.M.D.
- Dentist
- Jacksonville, AL
National Provider Identifier
1780607010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3308
- Practice address
- 505 Pelham Rd S
Jacksonville, AL 36265-2775 - Phone
- (256) 435-4464
- Fax
- (256) 435-2079
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 3308 | AL | Primary |
Addresses
Primary practice location
505 Pelham Rd S
Jacksonville, AL 36265-2775
Mailing address
505 Pelham Rd S
Jacksonville, AL 36265-2775
Phone (256) 435-4464
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000097747 | Medicaid | AL | |
| 793127 | Other | UNITED CONCORDIA ID | |
| 51097747 | Other | AL | BLUE CROSS/BLUE SHIELD ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3308 | AL | MD | Dentist |
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Dentist
- Rainbow City, AL
- NPI 1942570361
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1780607010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 PELHAM RD S",
"city": "JACKSONVILLE",
"state": "AL",
"postal_code": "362652775",
"telephone_number": "256-435-4464",
"fax_number": "256-435-2079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 PELHAM RD S",
"city": "JACKSONVILLE",
"state": "AL",
"postal_code": "362652775",
"telephone_number": "256-435-4464",
"fax_number": "256-435-2079"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNG",
"first_name": "WILLIAM",
"middle_name": "BRUCE",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AL",
"license": "3308",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000097747",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA ID",
"identifier": "793127",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS/BLUE SHIELD ID",
"identifier": "51097747",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.