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NPI Code Detail

MEDICARE: CHASE C YOUNGBLOOD DDS

MEDICARE: CHASE C YOUNGBLOOD DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist6052OK

General Provider Information

NPI Number : 1083877179
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHASE C YOUNGBLOOD DDS
Provider Business Mailing Address
First Line : 2025 S GORDON COOPER DR
Second Line :
City : SHAWNEE
State : OK
Zip : 74801-9005
Country : US
Telephone Number : 405-307-9704
Fax Number :
Provider Business Practice Location Address
First Line : 2025 S GORDON COOPER DR
Second Line :
City : SHAWNEE
State : OK
Zip : 74801-9005
Country : US
Telephone Number : 405-307-9704
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2008
Last Update Date : 09/13/2011

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Directions to “ CHASE C YOUNGBLOOD DDS” Practice Location

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