Provider Demographics
NPI:1457921959
Name:YOUNGBLOOD, ZACHARY COLE (DMD)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:COLE
Last Name:YOUNGBLOOD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1312 DUGDALE ST
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37405-3622
Mailing Address - Country:US
Mailing Address - Phone:229-300-6407
Mailing Address - Fax:
Practice Address - Street 1:1312 DUGDALE ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37405-3622
Practice Address - Country:US
Practice Address - Phone:229-300-6407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-28
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000121011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty