MEDICARE: NEW YOU DENTAL, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1053779132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW YOU DENTAL, LLC.

Provider Business Mailing Address
First Line	:	523 RAVINE ST FL 2
Second Line	:
City	:	DRAVOSBURG
State	:	PA
Zip	:	15034-1012
Country	:	US
Telephone Number	:	412-460-0415
Fax Number	:	412-460-0416

Provider Business Practice Location Address
First Line	:	523 RAVINE ST FL 2
Second Line	:
City	:	DRAVOSBURG
State	:	PA
Zip	:	15034-1012
Country	:	US
Telephone Number	:	412-460-0415
Fax Number	:	412-460-0416

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MS. CHRISTINA MARIE MARTIN
Credential	:
Telephone Number	:	412-460-0415

Provider Enumeration Date	:	02/04/2016
Last Update Date	:	02/04/2016

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Directions to “NEW YOU DENTAL, LLC. ” Practice Location

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