Provider Demographics
NPI:1104019884
Name:YANAGI, MARY M (DDS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:YANAGI
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 1:352 DUTTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-2806
Mailing Address - Country:US
Mailing Address - Phone:510-483-3732
Mailing Address - Fax:
Practice Address - Street 1:352 DUTTON AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-2806
Practice Address - Country:US
Practice Address - Phone:510-483-3732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30597122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist