MEDICARE: GARY U. OKAMOTO D.M.D. A PROFESSIONAL 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	1223P0221X	Pediatric Dentistry

General Provider Information

NPI Number	:	1821953076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY U. OKAMOTO D.M.D. A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	77564 COUNTRY CLUB DR STE 190A
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-0449
Country	:	US
Telephone Number	:	760-360-0622
Fax Number	:	760-360-6282

Provider Business Practice Location Address
First Line	:	77564 COUNTRY CLUB DR STE 190A
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-0449
Country	:	US
Telephone Number	:	760-360-0622
Fax Number	:	760-360-6282

Authorized Official
Title or Position	:	DOCTOR / OWNER
Name	:	DR. GARY U OKAMOTO
Credential	:	DMD
Telephone Number	:	760-360-0622

Provider Enumeration Date	:	12/19/2025
Last Update Date	:	12/19/2025

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