Provider Demographics
NPI:1134238397
Name:YAMUSAH, ARETHA (DDS MPH)
Entity type:Individual
Prefix:DR
First Name:ARETHA
Middle Name:
Last Name:YAMUSAH
Suffix:
Gender:F
Credentials:DDS MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 WEDGEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:MI
Mailing Address - Zip Code:49316
Mailing Address - Country:US
Mailing Address - Phone:616-554-0558
Mailing Address - Fax:
Practice Address - Street 1:2013 EAST CASTLE DR SE
Practice Address - Street 2:SUITE D
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508
Practice Address - Country:US
Practice Address - Phone:616-455-9900
Practice Address - Fax:616-455-9901
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017365122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist