Healthcare Provider Details

I. General information

NPI: 1851428536
Provider Name (Legal Business Name): DAVID KENNETH OKANO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 HILLTOP DR STE 209
ROCK SPRINGS WY
82901-5860
US

IV. Provider business mailing address

1208 HILLTOP DR STE 209
ROCK SPRINGS WY
82901-5860
US

V. Phone/Fax

Practice location:
  • Phone: 307-362-4867
  • Fax: 307-362-6441
Mailing address:
  • Phone: 307-362-4867
  • Fax: 307-362-6441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number820
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: