Provider Demographics
NPI:1922376821
Name:IWAMA, CELIA YURIE (DDS)
Entity type:Individual
Prefix:MS
First Name:CELIA
Middle Name:YURIE
Last Name:IWAMA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 SUTTER STREET
Mailing Address - Street 2:SUITE 2104
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108
Mailing Address - Country:US
Mailing Address - Phone:415-397-2244
Mailing Address - Fax:415-397-2246
Practice Address - Street 1:450 SUTTER STREET
Practice Address - Street 2:SUITE 2104
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108
Practice Address - Country:US
Practice Address - Phone:415-397-2244
Practice Address - Fax:415-397-2246
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40617122300000X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics