MEDICARE: YOUNG FAMILY DENTISTRY

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	122300000X	Dentist	7036	VA

General Provider Information

NPI Number	:	1609835560
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	2005 LYNNHAVEN PKWY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1410
Country	:	US
Telephone Number	:	757-554-0962
Fax Number	:	757-554-0964

Provider Business Practice Location Address
First Line	:	2005 LYNNHAVEN PKWY
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23456-1410
Country	:	US
Telephone Number	:	757-554-0962
Fax Number	:	757-554-0964

Authorized Official
Title or Position	:	OWNER
Name	:	MS. LYNNETTE R YOUNG
Credential	:	DMD
Telephone Number	:	757-554-0962

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	11/13/2012

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