Provider Demographics
NPI:1790883650
Name:YAMAGUCHI, SHUICHI (DDS PS)
Entity Type:Individual
Prefix:MR
First Name:SHUICHI
Middle Name:
Last Name:YAMAGUCHI
Suffix:
Gender:M
Credentials:DDS PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6113 ST ANDREWS DR
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275
Mailing Address - Country:US
Mailing Address - Phone:425-349-1343
Mailing Address - Fax:
Practice Address - Street 1:10217 19TH AVE SE
Practice Address - Street 2:STE 203
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208
Practice Address - Country:US
Practice Address - Phone:425-385-8130
Practice Address - Fax:425-385-2658
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA7482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist