Provider Demographics
NPI:1225303381
Name:YAMASHIRO, JAN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:YAMASHIRO
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 FOLSOM ST
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-6718
Mailing Address - Country:US
Mailing Address - Phone:303-443-3774
Mailing Address - Fax:303-442-6651
Practice Address - Street 1:1717 FOLSOM ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-6718
Practice Address - Country:US
Practice Address - Phone:303-443-3774
Practice Address - Fax:303-442-6651
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-24691223X0400X
CODEN - 103421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics