MEDICARE: DR. BEN YOUNT 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
1	1223G0001X	General Practice Dentistry	58769	CA

General Provider Information

NPI Number	:	1598068066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEN YOUNT DDS

Provider Business Mailing Address
First Line	:	720 N EL CAMINO REAL
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94401-3714
Country	:	US
Telephone Number	:	650-344-7888
Fax Number	:	650-348-1330

Provider Business Practice Location Address
First Line	:	720 N EL CAMINO REAL
Second Line	:
City	:	SAN MATEO
State	:	CA
Zip	:	94401-3714
Country	:	US
Telephone Number	:	650-344-7888
Fax Number	:	650-348-1330

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

Provider Enumeration Date	:	12/06/2010
Last Update Date	:	12/06/2010

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