Provider Demographics
NPI:1902007701
Name:YOUNGER, MARTHA HOPE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:HOPE
Last Name:YOUNGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 CHOCTAW RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1434
Mailing Address - Country:US
Mailing Address - Phone:662-242-5797
Mailing Address - Fax:662-327-5174
Practice Address - Street 1:220 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-5204
Practice Address - Country:US
Practice Address - Phone:662-328-5197
Practice Address - Fax:662-327-5174
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3160-001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice