Healthcare Provider Details

I. General information

NPI: 1124050208
Provider Name (Legal Business Name): ALAN AKIO MIYAKE MD, DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 N. STONEWALL AVE DCSB 206
OKLAHOMA CITY OK
73117-1214
US

IV. Provider business mailing address

1201 N. STONEWALL AVE. DCSB 206
OKLAHOMA CITY OK
73117-1214
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4441
  • Fax:
Mailing address:
  • Phone: 405-271-4441
  • Fax: 405-271-1134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number22636
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: