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General NPI Number Information
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NPI Number | 1336818525
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Entity Type | Individual
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Provider Name | BEN M YOUNG DDS
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Gender | Male
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Dates
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Enumeration Date | 09/10/2021
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Last Update Date | 09/10/2021
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Provider Practice Location Address
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Address Line | 2406 E SHAWNEE RD STE D
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City | MUSKOGEE
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State | OK
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Zip | 74403-1597
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Country | US
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Telephone | 918-351-7437
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Fax |
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Provider Business Mailing Address
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Address Line | 1497 DARLENE LN
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City | FORT GIBSON
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State | OK
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Zip | 74434-7823
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Country | US
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Telephone | 714-343-4075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7505
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License Number State | OK
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