Jerry E Young, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4625 Issued in KS

Practice address

208 West 4TH Street
Holton, KS 66436

Phone

(785) 364-4636

Fax

(785) 364-4815

NPI assigned

Sep 26, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jerry E. Young, D.D.S., P.a.

  • General Practice Dentistry
  • Holton, KS
  • NPI 1578664330
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1669573424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 WEST 4TH STREET",
            "address_2": "P.O. BOX 1028",
            "city": "HOLTON",
            "state": "KS",
            "postal_code": "66436",
            "telephone_number": "785-364-4636",
            "fax_number": "785-364-4815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 WEST 4TH STREET",
            "city": "HOLTON",
            "state": "KS",
            "postal_code": "66436",
            "telephone_number": "785-364-4636",
            "fax_number": "785-364-4815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "JERRY",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KS",
            "license": "4625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "17207",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED OF CONCORDIA",
            "identifier": "627506",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Phillip John Wassenberg, PT
• Kristi Watkins, BSN
• Wesley R Clark, OD & Nicole L Meerpohl, OD
• Barbara Wheeler, CPTA
• Sarah Wrench, OT
• Nancy J Zidek, M.D.
• Kaylie D'Ann Zimmerman, APRN-MSN

• General Practice Dentistry in Holton, KS
• Providers in Holton, KS by specialty
• General Practice Dentistry in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.