Healthcare Provider Details

I. General information

NPI: 1659643021
Provider Name (Legal Business Name): YUKA TANABE YAMAGISHI DDS, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2012
Last Update Date: 11/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 MONTROSE RD STE 100
ROCKVILLE MD
20852-4872
US

IV. Provider business mailing address

6001 MONTROSE RD STE 100
ROCKVILLE MD
20852-4872
US

V. Phone/Fax

Practice location:
  • Phone: 240-669-8647
  • Fax: 240-669-8453
Mailing address:
  • Phone: 240-669-8647
  • Fax: 240-669-8453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number13011
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: