MEDICARE: LAUREN YOUNG WILSTON 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	122300000X	Dentist	DS044425	PA
2	122300000X	Dentist	22DI02916200	NJ

General Provider Information

NPI Number	:	1851024202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN YOUNG WILSTON DMD

Provider Business Mailing Address
First Line	:	4 CARMEL PL
Second Line	:
City	:	NEWTOWN
State	:	PA
Zip	:	18940-1730
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	725 SKIPPACK PIKE STE 125
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-1704
Country	:	US
Telephone Number	:	215-641-2800
Fax Number	:

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

Provider Enumeration Date	:	07/04/2022
Last Update Date	:	05/28/2025

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