Provider Demographics
NPI:1407571516
Name:RIDGEVIEW FAMILY DENTAL R MCKELL YOUNG DMD PC
Entity Type:Organization
Organization Name:RIDGEVIEW FAMILY DENTAL R MCKELL YOUNG DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:L
Authorized Official - Last Name:KINGSOLVER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:816-853-2339
Mailing Address - Street 1:511 N RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-9336
Mailing Address - Country:US
Mailing Address - Phone:660-747-9117
Mailing Address - Fax:660-747-7615
Practice Address - Street 1:511 N RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-9336
Practice Address - Country:US
Practice Address - Phone:660-747-9117
Practice Address - Fax:660-747-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty