Healthcare Provider Details

I. General information

NPI: 1649428707
Provider Name (Legal Business Name): YUTAKA OKAMOTO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 04/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 TUCKERMAN LN SUITE 105
NORTH BETHESDA MD
20852-3474
US

IV. Provider business mailing address

5230 TUCKERMAN LN SUITE 105
NORTH BETHESDA MD
20852-3474
US

V. Phone/Fax

Practice location:
  • Phone: 240-667-7705
  • Fax:
Mailing address:
  • Phone: 240-667-7705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number13735
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13735
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code122400000X
TaxonomyDenturist
License Number13735
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: