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General NPI Number Information
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NPI Number | 1336311810
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Entity Type | Organization
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Legal Business Name | SHELLEY YOUNG DDS
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 17080 D. PARK AVE.
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-3349
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Country | US
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Telephone | 708-933-0747
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Fax | 708-933-6247
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Provider Business Mailing Address
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Address Line | 17080 D. PARK AVE.
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City | SOUTH HOLLAND
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State | IL
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Zip | 60473-3349
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Country | US
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Telephone | 708-933-0747
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Fax | 708-933-6247
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SHELLEY ANN YOUNG
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Credential | D.D.S.
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Telephone | 708-933-0747
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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 | 019023983
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License Number State | IL
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