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General NPI Number Information
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NPI Number | 1407571516
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Entity Type | Organization
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Legal Business Name | RIDGEVIEW FAMILY DENTAL R MCKELL YOUNG DMD PC
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 511 N RIDGEVIEW DR
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City | WARRENSBURG
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State | MO
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Zip | 64093-9336
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Country | US
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Telephone | 660-747-9117
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Fax | 660-747-7615
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Provider Business Mailing Address
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Address Line | 511 N RIDGEVIEW DR
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City | WARRENSBURG
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State | MO
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Zip | 64093-9336
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Country | US
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Telephone | 660-747-9117
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Fax | 660-747-7615
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JASON L KINGSOLVER
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Credential | DDS
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Telephone | 816-853-2339
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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 |
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License Number State |
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