Provider Demographics
NPI:1275647570
Name:YAUCH, KARL H (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:H
Last Name:YAUCH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 SW 320TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2570
Mailing Address - Country:US
Mailing Address - Phone:253-838-0661
Mailing Address - Fax:253-927-8378
Practice Address - Street 1:2315 SW 320TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2570
Practice Address - Country:US
Practice Address - Phone:253-838-0661
Practice Address - Fax:253-927-8378
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA37811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3781OtherLICENSE
WAUCC-410344OtherUNITED CONCORDIA
WA21946OtherLABOR AND INDUSTRIES
WA03449OtherWDS NUMBER
WAYA0430OtherREGENCE
WA3781OtherLICENSE
WA91-104-7240OtherTIN NUMBER