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General NPI Number Information
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NPI Number | 1790092468
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Entity Type | Individual
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Provider Name | JEFF YBARGUEN DDS
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Gender | Male
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Dates
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Enumeration Date | 09/01/2010
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Last Update Date | 09/01/2010
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Provider Practice Location Address
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Address Line | 3423 MERLIN DR STE 100
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7430
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Country | US
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Telephone | 208-542-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 3423 MERLIN DR # 100
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7430
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Country | US
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Telephone | 208-542-9900
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Fax |
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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 | 205755965
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 205755965
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License Number State | ID
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