Provider Demographics
NPI:1780728832
Name:YAMAGUCHI, MANAMI (MANAMI YAMAGUCHI DMD)
Entity type:Individual
Prefix:DR
First Name:MANAMI
Middle Name:
Last Name:YAMAGUCHI
Suffix:
Gender:F
Credentials:MANAMI YAMAGUCHI DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15074 BANGY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3110
Mailing Address - Country:US
Mailing Address - Phone:503-635-3306
Mailing Address - Fax:
Practice Address - Street 1:15074 BANGY RD
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3110
Practice Address - Country:US
Practice Address - Phone:503-635-3306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD7236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist