Provider Demographics
NPI:1508540147
Name:YOUNGBLADE, BAILEY (DDS)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:YOUNGBLADE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 GREY CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-3031
Mailing Address - Country:US
Mailing Address - Phone:515-339-9655
Mailing Address - Fax:
Practice Address - Street 1:1135 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-5313
Practice Address - Country:US
Practice Address - Phone:512-240-6623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist