MEDICARE: MS. CARLA YAMASHIRO DDS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	00008675	WA

General Provider Information

NPI Number	:	1174903298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CARLA YAMASHIRO DDS DDS

Provider Business Mailing Address
First Line	:	18008 STATE ROUTE 410 E STE A
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-7113
Country	:	US
Telephone Number	:	253-863-7005
Fax Number	:

Provider Business Practice Location Address
First Line	:	18008 STATE ROUTE 410 E STE A
Second Line	:
City	:	BONNEY LAKE
State	:	WA
Zip	:	98391-7113
Country	:	US
Telephone Number	:	253-863-7005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	06/18/2025

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