Bennett Van York, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

OS1679 Issued in TN

Practice address

1421 S 28TH Ave
Hattiesburg, MS 39402-3108

Phone

(601) 264-7611

Fax

(601) 268-0693

NPI assigned

Oct 10, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral Surgery

Education

University of Mississippi Medical Center School of Dentistry, 1961

Medicare assignment

May accept Medicare assignment

Group practices

Oral and Maxillofacial Surgery Clinic of South Misssissippi, P.a.Group PAC ID 2163501602, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• South Mississippi Oral Surgery & Implant Center PLLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Gulfport, MS
  • NPI 1780466300
  Medicare reassignment NPD Authorized official
• Oral & Maxillofacial Surgery Clinic of South Misssissippi, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Hattiesburg, MS
  • NPI 1578596060
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697587200000",
    "number": "1417045386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1421 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023108",
            "telephone_number": "601-264-7611",
            "fax_number": "601-268-0693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1421 S 28TH AVE",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394023108",
            "telephone_number": "601-264-7611",
            "fax_number": "601-268-0693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YORK",
        "first_name": "BENNETT",
        "middle_name": "VAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2023-10-18",
        "certification_date": "2023-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "OS1679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0660133",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "1182-65",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chieh Yang, MD
• Mark G Yeager, BCBA
• Benjamin M Yelverton, PA-C
• Amanda R Yingling
• William E Yoe, MD
• James A York, MD
• Ashley Young, LPC
• Jane Young
• Latarran D Young
• Nakyla Young

• Oral and Maxillofacial Surgery (Dentist) in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Oral and Maxillofacial Surgery (Dentist) in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.