Provider Demographics
NPI:1043354459
Name:IMAI-MARSHALL, YO (DDS)
Entity type:Individual
Prefix:
First Name:YO
Middle Name:
Last Name:IMAI-MARSHALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 SHEEP RANCH LOOP
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1659
Mailing Address - Country:US
Mailing Address - Phone:619-512-5455
Mailing Address - Fax:
Practice Address - Street 1:3855 AVOCADO BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7382
Practice Address - Country:US
Practice Address - Phone:619-670-4018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2014-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics