Individual
JON DEREK YATSUSHIRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
320 NE 5TH ST, GRESHAM, OR 97030-7308
(503) 665-0495
(503) 674-9196
Mailing address
320 NE 5TH ST, GRESHAM, OR 97030-7308
(503) 665-0495
(503) 674-9196
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
1571
HI
1223E0200X
Endodontics
35662
CA
1223E0200X
Endodontics
Primary
D7505
OR
Other
Enumeration date
11/16/2006
Last updated
08/03/2016
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