NPIMap

Organization Active NPI

Yelm Family Dentistry

  • General Practice Dentistry
  • Yelm, WA
National Provider Identifier
1932420650
Registry record updated Jun 16, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7336 Issued in WA
Legal business name
YELM FAMILY DENTISTRY
Practice address
106 Plaza Dr SE
BLDG a, Suite 1
Yelm, WA 98597-8798
Phone
(360) 458-1919
NPI assigned
Jun 16, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Clista Rakow
Title
Office Manager
Phone
(360) 458-1919

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 7336 WA Primary

Addresses

Primary practice location

106 Plaza Dr SE
BLDG a, Suite 1
Yelm, WA 98597-8798

Mailing address

PO Box 5350
Yelm, WA 98597-5350
Phone (360) 458-1919

Other identifiers 1

IdentifierTypeStateIssuer
5029046OtherWASTATE PROVIDER NUMBER

National Provider Directory

National Provider Directory

Locations

106 Plaza Dr SE
Ste A1
Yelm, WA 98597
Phone (360) 458-1919

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276646400000",
    "number": "1932420650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5350",
            "city": "YELM",
            "state": "WA",
            "postal_code": "985975350",
            "telephone_number": "360-458-1919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 PLAZA DR SE",
            "address_2": "BLDG A, SUITE 1",
            "city": "YELM",
            "state": "WA",
            "postal_code": "985978798",
            "telephone_number": "360-458-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YELM FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-16",
        "last_updated": "2010-06-16",
        "status": "A",
        "authorized_official_last_name": "RAKOW",
        "authorized_official_first_name": "CLISTA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "360-458-1919",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "7336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PROVIDER NUMBER",
            "identifier": "5029046",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yelm, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.