MEDICARE: YOUNG & YOUN DENTAL PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1255972337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG & YOUN DENTAL PLLC

Provider Business Mailing Address
First Line	:	11337 SUMMIT GALE WAY
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-1392
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3613 HULEN ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6813
Country	:	US
Telephone Number	:	817-731-2179
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. RYAN PARK
Credential	:	DDS
Telephone Number	:	718-734-8899

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	09/30/2019

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