Provider Demographics
NPI:1649340886
Name:YOUNGBAUER, DONALD GALE (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:GALE
Last Name:YOUNGBAUER
Suffix:
Gender:M
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:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:FORSYTH
Mailing Address - State:MT
Mailing Address - Zip Code:59327-0068
Mailing Address - Country:US
Mailing Address - Phone:406-346-2131
Mailing Address - Fax:406-346-2133
Practice Address - Street 1:1617 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORSYTH
Practice Address - State:MT
Practice Address - Zip Code:59327-0068
Practice Address - Country:US
Practice Address - Phone:406-346-2131
Practice Address - Fax:406-346-2133
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1537122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN8660OtherSTATE BOARD MN
MT0115726Medicaid
MT15374OtherBLUE CROSS