| Youthful Tooth | |
|
8201 Edgewater Dr Suite 105 &106 Oakland CA 94621 | |
| (510) 568-3577 | |
| (510) 568-8178 |
| Full Name | Youthful Tooth |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 8201 Edgewater Dr, Oakland, California |
| Authorized Official Name and Position | Jeffrey Alexander (OWNER) |
| Authorized Official Contact | 5105683577 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Youthful Tooth Po Box 14266 Oakland CA 94614 Ph: (510) 568-3577 | Youthful Tooth 8201 Edgewater Dr Suite 105 &106 Oakland CA 94621 Ph: (510) 568-3577 |
| NPI Number | 1801959515 |
|---|---|
| Provider Enumeration Date | 12/18/2006 |
| Last Update Date | 11/30/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801959515 | NPI | - | NPPES |
| G93765 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 26327 (California) | Primary |
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