MEDICARE: DAVID VERNON YOUNG D.D.S., M.D.S.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	144139	UT

General Provider Information

NPI Number	:	1629295050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID VERNON YOUNG D.D.S., M.D.S.

Provider Business Mailing Address
First Line	:	5102 COTTONWOOD LN
Second Line	:
City	:	HOLLADAY
State	:	UT
Zip	:	84117-7102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	622 E 4500 S STE 202
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-2922
Country	:	US
Telephone Number	:	801-266-3578
Fax Number	:	801-268-0444

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	07/08/2007

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