Provider Demographics
NPI:1548361918
Name:YANAGI, GLENN T (DDS)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:T
Last Name:YANAGI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CREEK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-7700
Mailing Address - Country:US
Mailing Address - Phone:949-733-3647
Mailing Address - Fax:
Practice Address - Street 1:33 CREEK RD STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7700
Practice Address - Country:US
Practice Address - Phone:949-733-3647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA391111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice