MEDICARE: YOUNG SMILES FAMILY DENTISTRY

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

General Provider Information

NPI Number	:	1154768554
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG SMILES FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	1311 SOUTH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1867
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 SOUTH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-1867
Country	:	US
Telephone Number	:	215-985-1717
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	QING YANG
Credential	:
Telephone Number	:	215-985-1717

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	05/28/2013

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Directions to “YOUNG SMILES FAMILY DENTISTRY ” Practice Location

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