MEDICARE: DR. GARY U OKAMOTO D.M.D.

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	1223P0221X	Pediatric Dentistry	34536	CA

General Provider Information

NPI Number	:	1669545752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY U OKAMOTO D.M.D.

Provider Business Mailing Address
First Line	:	77564 COUNTRY CLUB DR
Second Line	:	#190A
City	:	PALM DESERT
State	:	CA
Zip	:	92211-0484
Country	:	US
Telephone Number	:	760-360-0622
Fax Number	:	760-360-6282

Provider Business Practice Location Address
First Line	:	77564 COUNTRY CLUB DR
Second Line	:	#190A
City	:	PALM DESERT
State	:	CA
Zip	:	92211-0484
Country	:	US
Telephone Number	:	760-360-0622
Fax Number	:	760-360-6282

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	05/04/2012

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