Provider Demographics
NPI:1346327772
Name:YOUNG, JACOB DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:JACOB
Middle Name:DAVID
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8011 E 171ST ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-2261
Mailing Address - Country:US
Mailing Address - Phone:816-331-4800
Mailing Address - Fax:816-331-5309
Practice Address - Street 1:8011 E 171ST ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-2261
Practice Address - Country:US
Practice Address - Phone:816-331-4800
Practice Address - Fax:816-331-5309
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004022429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist