MEDICARE: BRADD S. YOSHIOKA, A DENTAL CORPORATION

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	261QD0000X	Dental Clinic/Center	62842	CA

General Provider Information

NPI Number	:	1952813040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRADD S. YOSHIOKA, A DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	554 3RD ST W
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6502
Country	:	US
Telephone Number	:	707-996-3016
Fax Number	:

Provider Business Practice Location Address
First Line	:	554 3RD ST W
Second Line	:
City	:	SONOMA
State	:	CA
Zip	:	95476-6502
Country	:	US
Telephone Number	:	707-996-3016
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRADD YOSHIOKA
Credential	:	DDS
Telephone Number	:	707-996-3016

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	10/30/2017

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