Healthcare Provider Details

I. General information

NPI: 1679583637
Provider Name (Legal Business Name): PEGGY JEAN YOUNG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BLUE PKWY
KANSAS CITY MO
64130-2807
US

IV. Provider business mailing address

3801 BLUE PKWY
KANSAS CITY MO
64130-2807
US

V. Phone/Fax

Practice location:
  • Phone: 816-923-5800
  • Fax: 816-448-2945
Mailing address:
  • Phone: 816-923-5800
  • Fax: 816-448-2945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number012562
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: