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Individual

BLAKE YOUNG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1000 SOUTHPARK BLVD STE C, WINSTON SALEM, NC 27127-5072
(336) 788-5073
Mailing address
1000 SOUTHPARK BLVD, WINSTON SALEM, NC 27127-5072

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12743
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1275751224
LEAL, SPANGLER AND JOHNSON DDS, PA GROUP NPI
NC
Enumeration date
02/07/2022
Last updated
08/02/2022
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