Healthcare Provider Details

I. General information

NPI: 1588472104
Provider Name (Legal Business Name): DAYTON OKI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2024
Last Update Date: 12/28/2024
Certification Date: 12/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6717 ROOSEVELT WAY NE APT 415
SEATTLE WA
98115-6696
US

IV. Provider business mailing address

6717 ROOSEVELT WAY NE APT 415
SEATTLE WA
98115-6696
US

V. Phone/Fax

Practice location:
  • Phone: 808-255-9849
  • Fax:
Mailing address:
  • Phone: 808-255-9849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDE61554196
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: