MEDICARE: DR. KENNETH A YORGEY DMD

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	041412111	VA

General Provider Information

NPI Number	:	1588683874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH A YORGEY DMD

Provider Business Mailing Address
First Line	:	3215 ROCK CREEK VILLA DR
Second Line	:	SUITE F
City	:	QUINTON
State	:	VA
Zip	:	23141-1656
Country	:	US
Telephone Number	:	804-932-5396
Fax Number	:	804-932-5399

Provider Business Practice Location Address
First Line	:	3215 ROCK CREEK VILLA DR
Second Line	:	SUITE F
City	:	QUINTON
State	:	VA
Zip	:	23141-1656
Country	:	US
Telephone Number	:	804-932-5396
Fax Number	:	804-932-5399

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	07/21/2016

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