Provider Demographics
NPI:1720597529
Name:OTSUBO, YUKO (DMD,BDS,CAGS,MSD)
Entity Type:Individual
Prefix:
First Name:YUKO
Middle Name:
Last Name:OTSUBO
Suffix:
Gender:F
Credentials:DMD,BDS,CAGS,MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CENTRE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2414
Mailing Address - Country:US
Mailing Address - Phone:617-964-0063
Mailing Address - Fax:
Practice Address - Street 1:46 FARNSWORTH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02210-1211
Practice Address - Country:US
Practice Address - Phone:617-802-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18600151223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics