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General NPI Number Information
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NPI Number | 1285788687
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Entity Type | Individual
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Provider Name | SHELLEY A YOUNG DDS
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Gender | Female
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 430 E 162ND ST SUITE # 550
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-2258
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Country | US
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Telephone | 773-415-6981
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Fax | 708-474-6229
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Provider Business Mailing Address
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Address Line | PO BOX 1183
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City | CALUMET CITY
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State | IL
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Zip | 60409-1183
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Country | US
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Telephone | 773-415-6981
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Fax | 708-474-6229
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019023983
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License Number State | IL
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