MEDICARE: DR. TODD ALVIN YOUNG D.D.S.

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	122300000X	Dentist	47340	CA

General Provider Information

NPI Number	:	1386866275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD ALVIN YOUNG D.D.S.

Provider Business Mailing Address
First Line	:	444 WEST MINER ST
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-2839
Country	:	US
Telephone Number	:	530-842-7323
Fax Number	:	530-842-4320

Provider Business Practice Location Address
First Line	:	444 WEST MINER ST
Second Line	:
City	:	YREKA
State	:	CA
Zip	:	96097-2839
Country	:	US
Telephone Number	:	530-842-7323
Fax Number	:

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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