Provider Demographics
NPI:1467526285
Name:YAMAOKA, DONALD MINEO (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MINEO
Last Name:YAMAOKA
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 1:2101 SOUTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-7037
Mailing Address - Country:US
Mailing Address - Phone:530-541-2994
Mailing Address - Fax:530-541-4770
Practice Address - Street 1:2101 SOUTH AVENUE
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-7037
Practice Address - Country:US
Practice Address - Phone:530-541-2994
Practice Address - Fax:530-541-4770
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice