Provider Demographics
NPI:1679583637
Name:YOUNG, PEGGY JEAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PEGGY
Middle Name:JEAN
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 BLUE PKWY
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64130-2807
Mailing Address - Country:US
Mailing Address - Phone:816-923-5800
Mailing Address - Fax:816-448-2945
Practice Address - Street 1:3801 BLUE PKWY
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64130-2807
Practice Address - Country:US
Practice Address - Phone:816-923-5800
Practice Address - Fax:816-448-2945
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0125621223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO400586103Medicaid