Individual
DR. KELLY ELIZABETH YOUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
2005 SAINT CHARLES ST STE 5, JASPER, IN 47546-9146
(812) 482-4321
(812) 634-6809
Mailing address
1219 RED DUNES RUN, AVON, IN 46123-9536
(812) 482-4321
(812) 634-6809
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12011027A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12011027A
LICENSE NUMBER
IN
Enumeration date
07/02/2007
Last updated
07/08/2007
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