Healthcare Provider Details

I. General information

NPI: 1265050389
Provider Name (Legal Business Name): JOSEPH TANAKA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2020
Last Update Date: 09/01/2021
Certification Date: 08/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18TH MEDICAL GROUP UNIT 5142
APO AP
96368-5142
US

IV. Provider business mailing address

PSC 80 BOX 20982
APO AP
96367-0094
US

V. Phone/Fax

Practice location:
  • Phone: 198-960-4817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7652
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: