Provider Demographics
NPI:1043425218
Name:MUSASHI, YASUKO (DDS)
Entity Type:Individual
Prefix:
First Name:YASUKO
Middle Name:
Last Name:MUSASHI
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 1:1315 DELAUNEY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2367
Mailing Address - Country:US
Mailing Address - Phone:706-322-9599
Mailing Address - Fax:
Practice Address - Street 1:94 MC CRARY ROAD
Practice Address - Street 2:
Practice Address - City:FORTSON
Practice Address - State:GA
Practice Address - Zip Code:31803
Practice Address - Country:US
Practice Address - Phone:706-987-8216
Practice Address - Fax:706-987-8220
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0133861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN013386OtherGA LIC