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General NPI Number Information
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NPI Number | 1730192618
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Entity Type | Organization
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Legal Business Name | ECOLOGIC DENTISTRY PLLC
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 18008 STATE ROUTE 410 E STE A
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City | BONNEY LAKE
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State | WA
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Zip | 98391-7113
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Country | US
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Telephone | 253-863-7005
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Fax | 253-863-6004
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Provider Business Mailing Address
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Address Line | 18008 STATE ROUTE 410 E STE A
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City | BONNEY LAKE
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State | WA
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Zip | 98391-7113
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Country | US
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Telephone | 253-863-7005
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Fax | 253-863-6004
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARLA A YAMASHIRO
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Credential | DDS
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Telephone | 253-863-7005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE00008675
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License Number State | WA
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