Healthcare Provider Details

I. General information

NPI: 1881091171
Provider Name (Legal Business Name): PAMELA ANN YOUNGER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S MAIDEN LANE
JOPLIN MO
64801
US

IV. Provider business mailing address

PO BOX 758 475 NELSON AVE
NEOSHO MO
64850
US

V. Phone/Fax

Practice location:
  • Phone: 417-782-0080
  • Fax: 417-782-0096
Mailing address:
  • Phone: 417-451-0619
  • Fax: 417-451-8903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number002825
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: