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General NPI Number Information
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NPI Number | 1992071898
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Entity Type | Organization
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Legal Business Name | JAN YAMASHIRO D.D.S., M.S.D., PROFESSIONAL LLC
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Dates
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Enumeration Date | 03/26/2012
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 1717 FOLSOM ST
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City | BOULDER
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State | CO
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Zip | 80302-6718
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Country | US
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Telephone | 303-443-3774
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Fax | 303-442-6651
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Provider Business Mailing Address
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Address Line | 1717 FOLSOM ST
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City | BOULDER
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State | CO
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Zip | 80302-6718
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Country | US
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Telephone | 303-443-3774
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Fax | 303-442-6651
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Authorized Official
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Title or Position | MEMBER
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Name | DR. JAN YAMASHIRO
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Credential | DDS, MSD
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Telephone | 303-443-3774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DT-10342
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License Number State | CO
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