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NPI Code Detail

MEDICARE: JAMES E YOUNG DDS

MEDICARE: JAMES E 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
1122300000XDentistJY015638MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D808133OTHERMIBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1346281383
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES E YOUNG DDS
Provider Business Mailing Address
First Line : 64580 VAN DYKE RD
Second Line : SUITE B
City : WASHINGTON
State : MI
Zip : 48095-2857
Country : US
Telephone Number : 586-752-3589
Fax Number : 586-752-0198
Provider Business Practice Location Address
First Line : 64580 VAN DYKE RD
Second Line : SUITE B
City : WASHINGTON
State : MI
Zip : 48095-2857
Country : US
Telephone Number : 586-752-3589
Fax Number : 586-752-0198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 07/08/2007

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