Provider Demographics
NPI:1376279695
Name:YOUNG, CARRIE ANN (RDH)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:ANN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:ABELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:109 CALIFORNIA ST, PO BOX 577
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918
Mailing Address - Country:US
Mailing Address - Phone:618-519-9200
Mailing Address - Fax:
Practice Address - Street 1:3115 WILLIAMSON COUNTY PKWY
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5235
Practice Address - Country:US
Practice Address - Phone:618-519-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020.015367124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist