MEDICARE: DR. ROGER 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	1223G0001X	General Practice Dentistry	DS003341	TN

General Provider Information

NPI Number	:	1013998434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER M YOUNG DDS

Provider Business Mailing Address
First Line	:	26741 MAIN ST
Second Line	:	PO BOX 488
City	:	ARDMORE
State	:	TN
Zip	:	38449-3120
Country	:	US
Telephone Number	:	931-427-2116
Fax Number	:	931-427-8290

Provider Business Practice Location Address
First Line	:	26741 MAIN ST
Second Line	:	26741 MAIN ST
City	:	ARDMORE
State	:	TN
Zip	:	38449-3120
Country	:	US
Telephone Number	:	931-427-2116
Fax Number	:	931-427-8290

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

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	03/26/2008

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