Provider Demographics
NPI:1417467366
Name:YOUNG FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:YOUNG FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-529-0688
Mailing Address - Street 1:2640 E 32ND ST STE 6
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4303
Mailing Address - Country:US
Mailing Address - Phone:417-781-3440
Mailing Address - Fax:417-708-0781
Practice Address - Street 1:2640 E 32ND ST STE 6
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4303
Practice Address - Country:US
Practice Address - Phone:417-781-3440
Practice Address - Fax:417-708-0781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2018-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO161111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty