Provider Demographics
NPI:1255451209
Name:YOUNGBLOOD, ANITA B (DMD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:B
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:180 MONTGOMERY ST
Mailing Address - Street 2:SUITE 2450
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4205
Mailing Address - Country:US
Mailing Address - Phone:415-433-4912
Mailing Address - Fax:415-433-2859
Practice Address - Street 1:180 MONTGOMERY ST
Practice Address - Street 2:SUITE 2450
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-4205
Practice Address - Country:US
Practice Address - Phone:415-433-4912
Practice Address - Fax:415-433-2859
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA348051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice