MEDICARE: ECOLOGIC DENTISTRY PLLC

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	122300000X	Dentist	DE00008675	WA

General Provider Information

NPI Number	:	1730192618
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ECOLOGIC DENTISTRY PLLC

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	:	253-863-6004

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	:	253-863-6004

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CARLA A YAMASHIRO
Credential	:	DDS
Telephone Number	:	253-863-7005

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	06/18/2025

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