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NPI Code Detail

MEDICARE: DR. JAMES BRYANT YOUNG D.D.S.

MEDICARE: DR. JAMES BRYANT 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
1122300000XDentistDS3820TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10022330OTHERTNB.C./B.S./ TN
2803388OTHERTNUNITED CONCORDIA ID

General Provider Information

NPI Number : 1407962616
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES BRYANT YOUNG D.D.S.
Provider Business Mailing Address
First Line : 95 POPLAR PLAINES ROAD
Second Line :
City : JACKSON
State : TN
Zip : 30305
Country : US
Telephone Number : 731-668-3728
Fax Number :
Provider Business Practice Location Address
First Line : 3067 N HIGHLAND AVE
Second Line :
City : JACKSON
State : TN
Zip : 38305-3411
Country : US
Telephone Number : 731-668-7916
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 07/08/2007

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