Healthcare Provider Details

I. General information

NPI: 1265745384
Provider Name (Legal Business Name): TAKASHI KOMABAYASHI DDS, MDS, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2010
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARL R. DARNALL ARMY MEDICAL CENTER 590 MEDICAL CENTER ROAD
FT HOOD TX
76544-5060
US

IV. Provider business mailing address

CARL R. DARNALL ARMY MEDICAL CENTER 590 MEDICAL CENTER ROAD
FT HOOD TX
76544-5060
US

V. Phone/Fax

Practice location:
  • Phone: 254-288-8888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4438
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: