Provider Demographics
NPI:1174081251
Name:YOSHIOKA, MISA LYNN (DMD)
Entity type:Individual
Prefix:DR
First Name:MISA
Middle Name:LYNN
Last Name:YOSHIOKA
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 1:1250 SE UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:WAUKEE
Mailing Address - State:IA
Mailing Address - Zip Code:50263-8831
Mailing Address - Country:US
Mailing Address - Phone:515-650-6378
Mailing Address - Fax:
Practice Address - Street 1:1250 SE UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-8831
Practice Address - Country:US
Practice Address - Phone:515-650-6378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-07
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA10182122300000X, 1223P0221X
WADE61137466122300000X, 1223P0221X
OH30.026068122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0395708Medicaid