MEDICARE: GEOFFREY T. OKADA, A PROFESSIONAL DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	32433	CA

General Provider Information

NPI Number	:	1295957918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEOFFREY T. OKADA, A PROFESSIONAL DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	2701 W ALAMEDA AVE
Second Line	:	SUITE 405
City	:	BURBANK
State	:	CA
Zip	:	91505-4402
Country	:	US
Telephone Number	:	818-843-0668
Fax Number	:	818-843-0768

Provider Business Practice Location Address
First Line	:	2701 W ALAMEDA AVE
Second Line	:	SUITE 405
City	:	BURBANK
State	:	CA
Zip	:	91505-4402
Country	:	US
Telephone Number	:	818-843-0668
Fax Number	:	818-843-0768

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GEOFFREY TOSHIO OKADA
Credential	:	D.D.S., M.S.
Telephone Number	:	818-843-0668

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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