Provider Demographics
NPI:1336346402
Name:YODER, GRIESER & SULLIVAN, DDS, LLP
Entity Type:Organization
Organization Name:YODER, GRIESER & SULLIVAN, DDS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:YODER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-895-4321
Mailing Address - Street 1:1880 POTTERY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2518
Mailing Address - Country:US
Mailing Address - Phone:360-895-4321
Mailing Address - Fax:360-895-4326
Practice Address - Street 1:1880 POTTERY AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2518
Practice Address - Country:US
Practice Address - Phone:360-895-4321
Practice Address - Fax:360-895-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5975122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5025796Medicaid