MEDICARE: YOUNG DENTAL CORPORATION

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	:	1225524226
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	1705 BRANHAM LN STE B4
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-5222
Country	:	US
Telephone Number	:	805-270-9322
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 BRANHAM LN STE B4
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95118-5222
Country	:	US
Telephone Number	:	408-264-7630
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREW J YOUNG
Credential	:
Telephone Number	:	805-270-9322

Provider Enumeration Date	:	07/03/2018
Last Update Date	:	07/07/2020

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Directions to “YOUNG DENTAL CORPORATION ” Practice Location

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