Healthcare Provider Details

I. General information

NPI: 1710035209
Provider Name (Legal Business Name): TRACEY K YAMAMOTO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W APACHE TRL SUITE 1
APACHE JUNCTION AZ
85220-3925
US

IV. Provider business mailing address

100 W APACHE TRL SUITE 1
APACHE JUNCTION AZ
85220-3925
US

V. Phone/Fax

Practice location:
  • Phone: 480-671-0070
  • Fax: 480-671-9757
Mailing address:
  • Phone: 480-671-0070
  • Fax: 480-671-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3955
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: