Individual
DR. JERRY E YOUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
208 WEST 4TH STREET, HOLTON, KS 66436
(785) 364-4636
(785) 364-4815
Mailing address
208 WEST 4TH STREET, P.O. BOX 1028, HOLTON, KS 66436
(785) 364-4636
(785) 364-4815
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4625
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17207
BLUE CROSS & BLUE SHIELD
KS
01
—
627506
UNITED OF CONCORDIA
KS
Enumeration date
09/26/2006
Last updated
07/09/2007
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