MEDICARE: DR. ERIKA TAKANAMI DDS

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	1223G0001X	General Practice Dentistry	DDS-09753	IA
2	1223G0001X	General Practice Dentistry	DE61231061	WA

General Provider Information

NPI Number	:	1598380362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIKA TAKANAMI DDS

Provider Business Mailing Address
First Line	:	3205 NE 78TH ST STE 11
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98665-0697
Country	:	US
Telephone Number	:	360-576-3570
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 NE 78TH ST STE 11
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98665-0697
Country	:	US
Telephone Number	:	360-576-3570
Fax Number	:

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

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	05/09/2022

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