MEDICARE: YOUNG 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	5629	OK

General Provider Information

NPI Number	:	1265589022
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	8470 NW EXPRESSWAY ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6009
Country	:	US
Telephone Number	:	405-728-8400
Fax Number	:	405-720-1777

Provider Business Practice Location Address
First Line	:	8470 NW EXPRESSWAY ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73162-6009
Country	:	US
Telephone Number	:	405-728-8400
Fax Number	:	405-720-1777

Authorized Official
Title or Position	:	OFFICE MANAGER DENTAL ASSISTANT
Name	:	MRS. JEANNETTE AMANDA BROWN
Credential	:
Telephone Number	:	405-728-8400

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	08/22/2020

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