Provider Demographics
NPI:1649907130
Name:YOUNG, KATHRYN CHAFFEE (DDS)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:CHAFFEE
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:RENE
Other - Last Name:CHAFFEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2525 SANDCREST BLVD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-3048
Mailing Address - Country:US
Mailing Address - Phone:812-372-6165
Mailing Address - Fax:812-372-3065
Practice Address - Street 1:2525 SANDCREST BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-3048
Practice Address - Country:US
Practice Address - Phone:812-372-6165
Practice Address - Fax:812-372-3065
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013846A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist