Healthcare Provider Details

I. General information

NPI: 1265453138
Provider Name (Legal Business Name): SIMMONS AND YOUNG, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 CRANE RIDGE DR
JACKSON MS
39216-4944
US

IV. Provider business mailing address

1855 CRANE RIDGE DR
JACKSON MS
39216-4944
US

V. Phone/Fax

Practice location:
  • Phone: 601-982-8585
  • Fax: 601-981-2323
Mailing address:
  • Phone: 601-982-8585
  • Fax: 601-981-2323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberPEDO 1-70
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberPEDO 61-83
License Number StateMS

VIII. Authorized Official

Name: DR. JOSEPH SPENCER YOUNG SR.
Title or Position: PARTNER
Credential: D.M.D.
Phone: 601-982-8585