Provider Demographics
NPI:1407191117
Name:YAMAMOTO, CHERYL (BS, RDH)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:BS, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W EL NORTE PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3983
Mailing Address - Country:US
Mailing Address - Phone:760-798-2314
Mailing Address - Fax:
Practice Address - Street 1:312 BISHOP DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4301
Practice Address - Country:US
Practice Address - Phone:760-798-8516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25029125J00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist
No174400000XOther Service ProvidersSpecialist