Provider Demographics
NPI:1699746529
Name:YOUNGQUIST, JEFFREY A (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:A
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 1:777 N 500 W
Mailing Address - Street 2:SUITE #201-A
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-1541
Mailing Address - Country:US
Mailing Address - Phone:385-204-2222
Mailing Address - Fax:801-375-0200
Practice Address - Street 1:777 N 500 W
Practice Address - Street 2:SUITE #201-A
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-1541
Practice Address - Country:US
Practice Address - Phone:385-204-2222
Practice Address - Fax:801-375-0200
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT59417961223G0001X
MND121671223G0001X
CA553191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice