Provider Demographics
NPI:1255437596
Name:IASELLA, ANDREA NICOLE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:NICOLE
Last Name:IASELLA
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 1:217 S 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3110
Mailing Address - Country:US
Mailing Address - Phone:509-249-0300
Mailing Address - Fax:509-249-2971
Practice Address - Street 1:217 S 12TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3110
Practice Address - Country:US
Practice Address - Phone:509-249-0300
Practice Address - Fax:509-249-2971
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000093631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice