Provider Demographics
NPI:1285788687
Name:YOUNG, SHELLEY A (DDS)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1183
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-1183
Mailing Address - Country:US
Mailing Address - Phone:773-415-6981
Mailing Address - Fax:708-474-6229
Practice Address - Street 1:430 E 162ND ST
Practice Address - Street 2:SUITE # 550
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-2258
Practice Address - Country:US
Practice Address - Phone:773-415-6981
Practice Address - Fax:708-474-6229
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190239831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice