Healthcare Provider Details

I. General information

NPI: 1134536857
Provider Name (Legal Business Name): KATSUSHI OKAZAKI D.D.S., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 03/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 E 24TH ST 7W
NEW YORK NY
10010-4020
US

IV. Provider business mailing address

10420 QUEENS BLVD APT 9-Y
FOREST HILLS NY
11375-3629
US

V. Phone/Fax

Practice location:
  • Phone: 612-812-5238
  • Fax:
Mailing address:
  • Phone: 612-812-5238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number000052
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: