Provider Demographics
NPI:1356405443
Name:GORDON YAMAGUCHI DDS PS
Entity type:Organization
Organization Name:GORDON YAMAGUCHI DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:M
Authorized Official - Last Name:YAMAGUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-943-9480
Mailing Address - Street 1:108 22ND AVE SW
Mailing Address - Street 2:STE 24
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-2871
Mailing Address - Country:US
Mailing Address - Phone:360-943-9480
Mailing Address - Fax:360-943-9568
Practice Address - Street 1:108 22ND AVE SW
Practice Address - Street 2:STE 24
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-2871
Practice Address - Country:US
Practice Address - Phone:360-943-9480
Practice Address - Fax:360-943-9568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty