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General NPI Number Information
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NPI Number | 1508075086
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Entity Type | Organization
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Legal Business Name | PHI AND MIYAMOTO DENTAL CORPORATION
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 3257 CAMINO DE LOS COCHES SUITE 302
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City | CARLSBAD
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State | CA
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Zip | 92009-8966
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Country | US
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Telephone | 760-942-5888
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Fax |
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Provider Business Mailing Address
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Address Line | 3257 CAMINO DE LOS COCHES SUITE 302
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City | CARLSBAD
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State | CA
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Zip | 92009-8966
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GERALD MIYAMOTO
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Credential | D.D.S.
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Telephone | 760-942-5888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47291
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License Number State | CA
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