Provider Demographics
NPI:1598903023
Name:YASUHIRO, STANLEY YORK (DDS)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:YORK
Last Name:YASUHIRO
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 1:667 NORTH MARINE DRIVE
Mailing Address - Street 2:PACIFICA PLAZA BLDG., STE. 204
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913
Mailing Address - Country:US
Mailing Address - Phone:671-646-3679
Mailing Address - Fax:671-646-2824
Practice Address - Street 1:667 NORTH MARINE DRIVE
Practice Address - Street 2:PACIFICA PLAZA BLDG., STE. 204
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-646-3679
Practice Address - Fax:671-646-2824
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUD7911223G0001X
CA315471223G0001X
WI3156-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice