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General NPI Number Information
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NPI Number | 1720877897
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Entity Type | Organization
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Legal Business Name | BAILEY A YOUNGBLADE, LLC
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 617 RYAN ST
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City | PEWAUKEE
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State | WI
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Zip | 53072-1800
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Country | US
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Telephone | 262-695-8600
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Fax |
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Provider Business Mailing Address
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Address Line | N53W16418 WHITETAIL RUN
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-0623
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Country | US
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Telephone | 515-339-9655
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BAILEY YOUNGBLADE
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Credential | DDS
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Telephone | 515-339-9655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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