Healthcare Provider Details

I. General information

NPI: 1972743458
Provider Name (Legal Business Name): MICHAEL ALAN MIYASAKI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 05/17/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1428 U STREET
SACRAMENTO CA
95818-1489
US

IV. Provider business mailing address

1428 U STREET
SACRAMENTO CA
95818-1489
US

V. Phone/Fax

Practice location:
  • Phone: 916-442-8911
  • Fax: 702-478-6469
Mailing address:
  • Phone: 916-747-3038
  • Fax: 702-478-6469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number35433
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3783
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35433
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: