Healthcare Provider Details

I. General information

NPI: 1861315475
Provider Name (Legal Business Name): JOLENE YOUNG RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W WARNER RD STE 9
CHANDLER AZ
85224-2758
US

IV. Provider business mailing address

2925 E TRIGGER WAY
GILBERT AZ
85297-6033
US

V. Phone/Fax

Practice location:
  • Phone: 480-963-5821
  • Fax:
Mailing address:
  • Phone: 480-522-4004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH6864
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: