Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 64725 | CA |
NPI | 1003292608 |
---|---|
Provider Name | Jeffrey Youngberg |
First Address | Vacaville, CA 95688-4646 |
Second Address | Vacaville, CA 95688-4646 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2015 |
Last Update Date | 16/03/2017 |