MEDICARE: DR. FREDERICK T. YOUNG DMD

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	1011	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1011	OTHER	NV	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1700806718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDERICK T. YOUNG DMD

Provider Business Mailing Address
First Line	:	804 E ROBINSON ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-4734
Country	:	US
Telephone Number	:	775-883-7773
Fax Number	:	775-883-9793

Provider Business Practice Location Address
First Line	:	804 E ROBINSON ST
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-4734
Country	:	US
Telephone Number	:	775-883-7773
Fax Number	:	775-883-9793

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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