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General NPI Number Information
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NPI Number | 1104193473
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Entity Type | Organization
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Legal Business Name | PAUL K. TAKEMOTO, D.D.S., PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 144 W LOS ANGELES AVE
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City | MOORPARK
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State | CA
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Zip | 93021-1898
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Country | US
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Telephone | 805-553-1980
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Fax | 805-553-1981
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Provider Business Mailing Address
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Address Line | 144 W LOS ANGELES AVE
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City | MOORPARK
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State | CA
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Zip | 93021-1898
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Country | US
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Telephone | 805-553-1980
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Fax | 805-553-1981
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAUL K. TAKEMOTO
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Credential | DDS
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Telephone | 805-553-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 35455
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License Number State | CA
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