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General NPI Number Information
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NPI Number | 1972956647
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Entity Type | Individual
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Provider Name | KELBY M OKADA D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/19/2016
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Last Update Date | 01/24/2023
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Provider Practice Location Address
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Address Line | 3412 E US HIGHWAY 377
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City | GRANBURY
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State | TX
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Zip | 76049
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Country | US
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Telephone | 817-776-8073
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Fax |
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Provider Business Mailing Address
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Address Line | 3412 E US HIGHWAY 377
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City | GRANBURY
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State | TX
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Zip | 76049-7418
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Country | US
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Telephone | 817-776-8073
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS040979
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 33368
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License Number State | TX
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