Healthcare Provider Details

I. General information

NPI: 1932022654
Provider Name (Legal Business Name): MICHAEL OKUMOTO, DDS, DENTAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2026
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41268 FREMONT BLVD
FREMONT CA
94538-4823
US

IV. Provider business mailing address

41268 FREMONT BLVD
FREMONT CA
94538-4823
US

V. Phone/Fax

Practice location:
  • Phone: 510-656-7778
  • Fax:
Mailing address:
  • Phone: 909-576-3510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL OKUMOTO
Title or Position: OFFICER
Credential: DDS
Phone: 909-576-3510