MEDICARE: DR. DAPHNE CASSANDRA FERGUSON-YOUNG 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	DS3779	TN

General Provider Information

NPI Number	:	1619188372
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAPHNE CASSANDRA FERGUSON-YOUNG DDS

Provider Business Mailing Address
First Line	:	2120 LEBANON PIKE
Second Line	:	#38
City	:	NASHVILLE
State	:	TN
Zip	:	37210-2417
Country	:	US
Telephone Number	:	615-327-6775
Fax Number	:	615-327-6367

Provider Business Practice Location Address
First Line	:	1005 DR. D.B. TODD
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37208-3599
Country	:	US
Telephone Number	:	615-327-6775
Fax Number	:	615-327-6367

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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