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General NPI Number Information
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NPI Number | 1871630673
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Entity Type | Individual
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Provider Name | ROY MIYAMOTO DDS
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 4444 TWEEDY BLVD
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City | SOUTH GATE
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State | CA
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Zip | 90280-6304
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Country | US
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Telephone | 323-564-2444
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Fax | 323-249-7565
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Provider Business Mailing Address
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Address Line | 65 TAVELLA PL
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City | FOOTHILL RANCH
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State | CA
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Zip | 92610-2206
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Country | US
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Telephone |
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Fax | 323-249-7565
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 33633
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License Number State | CA
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