Provider Demographics
NPI:1760577100
Name:MANABE, YURIYA (DMD)
Entity Type:Individual
Prefix:
First Name:YURIYA
Middle Name:
Last Name:MANABE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 SW 187TH AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALOHA
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3400 SW 187TH AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:ALOHA
Practice Address - State:OR
Practice Address - Zip Code:97006-3131
Practice Address - Country:US
Practice Address - Phone:503-649-2166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD6429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist