Provider Demographics
NPI:1336818525
Name:YOUNG, BEN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:M
Last Name:YOUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1497 DARLENE LN
Mailing Address - Street 2:
Mailing Address - City:FORT GIBSON
Mailing Address - State:OK
Mailing Address - Zip Code:74434-7823
Mailing Address - Country:US
Mailing Address - Phone:714-343-4075
Mailing Address - Fax:
Practice Address - Street 1:2406 E SHAWNEE RD STE D
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-1597
Practice Address - Country:US
Practice Address - Phone:918-351-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist