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General NPI Number Information
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NPI Number | 1225373996
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Entity Type | Individual
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Provider Name | JILL ILANA YOUNG D.M.D
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Gender | Female
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 09/10/2014
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Provider Practice Location Address
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Address Line | 4905 OLD ORCHARD CENTER SUITE #216
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City | SKOKIE
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State | IL
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Zip | 60077
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Country | US
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Telephone | 847-676-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 30 EAST HURON ST. APT #1105
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City | CHICAGO
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State | IL
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Zip | 60611
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Country | US
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Telephone | 219-741-3937
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.029767
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 021.002598
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License Number State | IL
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