MEDICARE: DR. EDWARD D 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	2901013995	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073656195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD D YOUNG DDS

Provider Business Mailing Address
First Line	:	4310 LEONARD ST NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-8447
Country	:	US
Telephone Number	:	616-791-0230
Fax Number	:

Provider Business Practice Location Address
First Line	:	4310 LEONARD ST NW
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49534-8447
Country	:	US
Telephone Number	:	616-791-0230
Fax Number	:

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

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	07/09/2007

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Directions to “ DR. EDWARD D YOUNG DDS” Practice Location

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