Provider Demographics
NPI:1821184045
Name:YOUNG, DAN KIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:KIP
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:417-781-0781
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
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO16111223G0001X
MO161111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice