MEDICARE: DR. MATTHEW ORVAL 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	9908	CO

General Provider Information

NPI Number	:	1124284104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW ORVAL YOUNG D.D.S.

Provider Business Mailing Address
First Line	:	718 MALETA LN
Second Line	:	SUITE 101
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-7602
Country	:	US
Telephone Number	:	303-660-8540
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 MALETA LN
Second Line	:	SUITE 101
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-7602
Country	:	US
Telephone Number	:	303-660-8540
Fax Number	:

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

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	05/04/2012

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