# JERRY E. YOUNG, D.D.S., P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1578664330
- **Authorized official:** DR. JERRY E YOUNG DDS (PRESIDENT)
- **Authorized official phone:** (785) 364-4636

## Contact information

- **Practice address:** 208 WEST 4TH STREET, HOLTON, KS 66436
- **Practice address phone:** (785) 364-4636
- **Practice address fax:** (785) 364-4815
- **Mailing address:** 208 WEST 4TH STREET, HOLTON, KS 66436
- **Mailing address phone:** (785) 364-4636
- **Mailing address fax:** (785) 364-4815

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4625 | KS | Yes |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 17207 | BLUE CROSS & BLUE SHIELD | KS |
| 01 | — | 627506 | UNITED CONCORDIA | KS |