Healthcare Provider Details

I. General information

NPI: 1811986607
Provider Name (Legal Business Name): DAVID M. OKUJI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1667 DOMINICAN WAY SUITE 232
SANTA CRUZ CA
95065-1518
US

IV. Provider business mailing address

1667 DOMINICAN WAY SUITE 232
SANTA CRUZ CA
95065-1518
US

V. Phone/Fax

Practice location:
  • Phone: 831-476-5512
  • Fax: 831-687-0102
Mailing address:
  • Phone: 831-476-5512
  • Fax: 831-687-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number28057
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: