Provider Demographics
NPI:1932899713
Name:YOUNGER, TYESHA (DMD)
Entity type:Individual
Prefix:DR
First Name:TYESHA
Middle Name:
Last Name:YOUNGER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 E DATE PALM PASEO APT 3006
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-7611
Mailing Address - Country:US
Mailing Address - Phone:951-204-7606
Mailing Address - Fax:
Practice Address - Street 1:6336 FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-4732
Practice Address - Country:US
Practice Address - Phone:213-556-1746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA110208122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist