Provider Demographics
NPI:1336311810
Name:SHELLEY YOUNG DDS
Entity type:Organization
Organization Name:SHELLEY YOUNG DDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-933-0747
Mailing Address - Street 1:17080 D. PARK AVE.
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3349
Mailing Address - Country:US
Mailing Address - Phone:708-933-0747
Mailing Address - Fax:708-933-6247
Practice Address - Street 1:17080 D. PARK AVE.
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3349
Practice Address - Country:US
Practice Address - Phone:708-933-0747
Practice Address - Fax:708-933-6247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019023983122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty