Provider Demographics
NPI:1972713543
Name:YAMAMOTO, RICHARD M (DDS)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:YAMAMOTO
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 1:202 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-3604
Mailing Address - Country:US
Mailing Address - Phone:805-525-1589
Mailing Address - Fax:805-525-3245
Practice Address - Street 1:202 S 8TH ST
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-3604
Practice Address - Country:US
Practice Address - Phone:805-525-1589
Practice Address - Fax:805-525-3245
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA243571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice