Provider Demographics
NPI:1710035209
Name:YAMAMOTO, TRACEY K (DDS)
Entity Type:Individual
Prefix:MS
First Name:TRACEY
Middle Name:K
Last Name:YAMAMOTO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W APACHE TRL
Mailing Address - Street 2:SUITE 1
Mailing Address - City:APACHE JUNCTION
Mailing Address - State:AZ
Mailing Address - Zip Code:85220-3925
Mailing Address - Country:US
Mailing Address - Phone:480-671-0070
Mailing Address - Fax:480-671-9757
Practice Address - Street 1:100 W APACHE TRL
Practice Address - Street 2:SUITE 1
Practice Address - City:APACHE JUNCTION
Practice Address - State:AZ
Practice Address - Zip Code:85220-3925
Practice Address - Country:US
Practice Address - Phone:480-671-0070
Practice Address - Fax:480-671-9757
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3955122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist