Provider Demographics
NPI:1003219064
Name:WADA, TOMOKO (DDS)
Entity Type:Individual
Prefix:DR
First Name:TOMOKO
Middle Name:
Last Name:WADA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 W 34TH ST STE 127
Mailing Address - Street 2:OSTROW SCHOOL OF DENTISTRY OF USC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90089-0641
Mailing Address - Country:US
Mailing Address - Phone:213-740-3410
Mailing Address - Fax:
Practice Address - Street 1:925 W 34TH ST STE 127
Practice Address - Street 2:OSTROW SCHOOL OF DENTISTRY OF USC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-0058
Practice Address - Country:US
Practice Address - Phone:213-740-3410
Practice Address - Fax:213-740-3573
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-06
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64110122300000X
WADE60264061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist