MEDICARE: GLENN J. YORITA DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DE00005976	WA

General Provider Information

NPI Number	:	1770618670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN J. YORITA DDS, MS

Provider Business Mailing Address
First Line	:	465 RAINIER BLVD N
Second Line	:	SUITE B
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2826
Country	:	US
Telephone Number	:	425-391-1814
Fax Number	:	425-837-9233

Provider Business Practice Location Address
First Line	:	465 RAINIER BLVD N
Second Line	:	SUITE B
City	:	ISSAQUAH
State	:	WA
Zip	:	98027-2826
Country	:	US
Telephone Number	:	425-391-1814
Fax Number	:	425-837-9233

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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