MEDICARE: DR. DANNY J. YOUNGER D.M.D.

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		IL

General Provider Information

NPI Number	:	1760449391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANNY J. YOUNGER D.M.D.

Provider Business Mailing Address
First Line	:	1318 D'ADRIAN PROFESSIONAL PARK
Second Line	:
City	:	GODFREY
State	:	IL
Zip	:	62035
Country	:	US
Telephone Number	:	618-466-9050
Fax Number	:	618-466-9085

Provider Business Practice Location Address
First Line	:	1318 DADRIAN PROFESSIONAL PARK
Second Line	:
City	:	GODFREY
State	:	IL
Zip	:	62035-1685
Country	:	US
Telephone Number	:	618-466-9050
Fax Number	:	618-466-9085

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	07/08/2007

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