Healthcare Provider Details

I. General information

NPI: 1275647570
Provider Name (Legal Business Name): KARL H YAUCH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 SW 320TH ST SUITE B
FEDERAL WAY WA
98023-2570
US

IV. Provider business mailing address

2315 SW 320TH ST SUITE B
FEDERAL WAY WA
98023-2570
US

V. Phone/Fax

Practice location:
  • Phone: 253-838-0661
  • Fax: 253-927-8378
Mailing address:
  • Phone: 253-838-0661
  • Fax: 253-927-8378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3781
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: