Provider Demographics
NPI:1982742649
Name:YOUNGQUIST, ADAM JASON (DDS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:JASON
Last Name:YOUNGQUIST
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 1:1103 SOUTH SHIELDS STREET
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-4524
Mailing Address - Country:US
Mailing Address - Phone:970-484-3213
Mailing Address - Fax:970-484-4007
Practice Address - Street 1:1103 SOUTH SHIELDS STREET
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-4524
Practice Address - Country:US
Practice Address - Phone:970-484-3213
Practice Address - Fax:970-484-4007
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist