Organization
YELM FAMILY DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CLISTA RAKOW (OFFICE MANAGER)
(360) 458-1919
Entity
Organization
Contact information
Practice address
106 PLAZA DR SE, BLDG A, SUITE 1, YELM, WA 98597-8798
(360) 458-1919
Mailing address
PO BOX 5350, YELM, WA 98597-5350
(360) 458-1919
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7336
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5029046
STATE PROVIDER NUMBER
WA
Enumeration date
06/16/2010
Last updated
06/16/2010
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