Healthcare Provider Details

I. General information

NPI: 1821953076
Provider Name (Legal Business Name): GARY U. OKAMOTO D.M.D. A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77564 COUNTRY CLUB DR STE 190A
PALM DESERT CA
92211-0449
US

IV. Provider business mailing address

77564 COUNTRY CLUB DR STE 190A
PALM DESERT CA
92211-0449
US

V. Phone/Fax

Practice location:
  • Phone: 760-360-0622
  • Fax: 760-360-6282
Mailing address:
  • Phone: 760-360-0622
  • Fax: 760-360-6282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY U OKAMOTO
Title or Position: DOCTOR / OWNER
Credential: DMD
Phone: 760-360-0622