MEDICARE: DR. DAVID TAKASHI SUGIYAMA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	10253	CO

General Provider Information

NPI Number	:	1396052619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID TAKASHI SUGIYAMA D.D.S.

Provider Business Mailing Address
First Line	:	4284 TRAIL BOSS DR STE 110
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-7521
Country	:	US
Telephone Number	:	303-688-3398
Fax Number	:

Provider Business Practice Location Address
First Line	:	1189 S PERRY ST STE 250
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80104-1959
Country	:	US
Telephone Number	:	303-688-3398
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	05/28/2026

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