Provider Demographics
NPI:1508540147
Name:YOUNGBLADE, BAILEY (DDS)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:YOUNGBLADE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 RYAN ST STE 270
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-1880
Mailing Address - Country:US
Mailing Address - Phone:515-339-9655
Mailing Address - Fax:262-691-5600
Practice Address - Street 1:617 RYAN ST STE 270
Practice Address - Street 2:
Practice Address - City:PEWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53072-1880
Practice Address - Country:US
Practice Address - Phone:262-695-8600
Practice Address - Fax:262-691-3469
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39656122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist