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General NPI Number Information
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NPI Number | 1508540147
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Entity Type | Individual
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Provider Name | BAILEY YOUNGBLADE DDS
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Gender | Female
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 617 RYAN ST STE 270
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City | PEWAUKEE
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State | WI
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Zip | 53072-1880
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Country | US
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Telephone | 262-695-8600
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Fax | 262-691-3469
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Provider Business Mailing Address
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Address Line | 617 RYAN ST STE 270
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City | PEWAUKEE
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State | WI
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Zip | 53072-1880
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Country | US
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Telephone | 515-339-9655
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Fax | 262-691-5600
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 39656
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License Number State | TX
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