MEDICARE: KENNETH A. YORGEY DMD PC

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	261QD0000X	Dental Clinic/Center	0401412111	VA

General Provider Information

NPI Number	:	1669624755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNETH A. YORGEY DMD PC

Provider Business Mailing Address
First Line	:	3215 ROCK CREEK VILLA DR
Second Line	:	SUITE F
City	:	QUINTON
State	:	VA
Zip	:	23141-1656
Country	:	US
Telephone Number	:	804-932-5396
Fax Number	:	804-932-5399

Provider Business Practice Location Address
First Line	:	3215 ROCK CREEK VILLA DR
Second Line	:	SUITE F
City	:	QUINTON
State	:	VA
Zip	:	23141-1656
Country	:	US
Telephone Number	:	804-932-5396
Fax Number	:	804-932-5399

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KENNETH ALLEN YORGEY
Credential	:	DMD
Telephone Number	:	804-932-5396

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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