MEDICARE: DR. JAMES M YOUNG DDS

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	1223E0200X	Endodontics	DT-2049	HI
2	1223G0001X	General Practice Dentistry	2049	HI
3	1223E0200X	Endodontics	39329	TX

General Provider Information

NPI Number	:	1194707554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES M YOUNG DDS

Provider Business Mailing Address
First Line	:	1615 TRUEMPER ST BLDG 6418
Second Line	:
City	:	JBSA LACKLAND
State	:	TX
Zip	:	78236-5511
Country	:	US
Telephone Number	:	210-292-0650
Fax Number	:

Provider Business Practice Location Address
First Line	:	1615 TRUEMPER ST BLDG 6418
Second Line	:
City	:	JBSA LACKLAND
State	:	TX
Zip	:	78236-5511
Country	:	US
Telephone Number	:	210-292-0650
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	10/10/2023

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