MEDICARE: DEAN C. YOUNCE, DMD, PA

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	D-3178-OS	ID

General Provider Information

NPI Number	:	1457378382
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEAN C. YOUNCE, DMD, PA

Provider Business Mailing Address
First Line	:	5266 N EAGLE RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-0945
Country	:	US
Telephone Number	:	208-939-4242
Fax Number	:

Provider Business Practice Location Address
First Line	:	5266 N EAGLE RD
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-0945
Country	:	US
Telephone Number	:	208-939-4242
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEAN CHARLES YOUNCE
Credential	:	D.M.D.
Telephone Number	:	208-939-4242

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	09/05/2007

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