Healthcare Provider Details

I. General information

NPI: 1295957918
Provider Name (Legal Business Name): GEOFFREY T. OKADA, A PROFESSIONAL DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 W ALAMEDA AVE SUITE 405
BURBANK CA
91505-4402
US

IV. Provider business mailing address

2701 W ALAMEDA AVE SUITE 405
BURBANK CA
91505-4402
US

V. Phone/Fax

Practice location:
  • Phone: 818-843-0668
  • Fax: 818-843-0768
Mailing address:
  • Phone: 818-843-0668
  • Fax: 818-843-0768

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number32433
License Number StateCA

VIII. Authorized Official

Name: DR. GEOFFREY TOSHIO OKADA
Title or Position: OWNER
Credential: D.D.S., M.S.
Phone: 818-843-0668