Healthcare Provider Details

I. General information

NPI: 1386566693
Provider Name (Legal Business Name): GEORGE YOUSSEF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78461 CA 111
LA QUINTA CA
92253
US

IV. Provider business mailing address

78461 CA 111 111
LA QUINTA CA
92253
US

V. Phone/Fax

Practice location:
  • Phone: 760-564-5455
  • Fax:
Mailing address:
  • Phone: 760-564-5455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: