Provider Demographics
NPI:1326059874
Name:YAMADA, RUSSELL S (DMD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:S
Last Name:YAMADA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3062 NW SNOWBERRY PL
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3518
Mailing Address - Country:US
Mailing Address - Phone:541-754-9891
Mailing Address - Fax:
Practice Address - Street 1:3062 NW SNOWBERRY PL
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3518
Practice Address - Country:US
Practice Address - Phone:541-754-9891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD55811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics