# YELM FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932420650
- **Authorized official:** MRS. CLISTA RAKOW (OFFICE MANAGER)
- **Authorized official phone:** (360) 458-1919

## Contact information

- **Practice address:** 106 PLAZA DR SE, BLDG A, SUITE 1, YELM, WA 98597-8798
- **Practice address phone:** (360) 458-1919
- **Mailing address:** PO BOX 5350, YELM, WA 98597-5350
- **Mailing address phone:** (360) 458-1919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 7336 | WA | Yes |

## Other

- **Enumeration date:** 06/16/2010
- **Last updated:** 06/16/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 5029046 | STATE PROVIDER NUMBER | WA |