MEDICARE: YOUNGSTOWN SMILES YOUTH DENTISTRY LLCMICHAEL CRITES 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598894388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNGSTOWN SMILES YOUTH DENTISTRY LLCMICHAEL CRITES DDS

Provider Business Mailing Address
First Line	:	16 ARCADE UNIT 198747
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37219-1994
Country	:	US
Telephone Number	:	615-750-0343
Fax Number	:	615-986-1705

Provider Business Practice Location Address
First Line	:	3353 MAHONING AVE
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44509-2617
Country	:	US
Telephone Number	:	330-792-9600
Fax Number	:	330-792-9650

Authorized Official
Title or Position	:	MANAGER, L & C
Name	:	MRS. JENELL STUMP
Credential	:
Telephone Number	:	615-750-0343

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/09/2014

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