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General NPI Number Information
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NPI Number | 1437246154
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Entity Type | Individual
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Provider Name | FRED OSAMU SAKAMOTO DDS
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Gender | Male
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 7334 E BROAD ST
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City | BLACKLICK
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State | OH
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Zip | 43004-9239
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Country | US
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Telephone | 614-575-0070
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Fax | 614-575-0068
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Provider Business Mailing Address
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Address Line | 3060 LEWIS CENTER RD
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City | LEWIS CENTER
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State | OH
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Zip | 43035-9207
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Country | US
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Telephone | 740-548-4622
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Fax | 740-548-2338
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 30016951
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License Number State | OH
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