Provider Demographics
NPI:1063817054
Name:OTANI, TAKAFUMI (DDS, PHD, MSD)
Entity Type:Individual
Prefix:
First Name:TAKAFUMI
Middle Name:
Last Name:OTANI
Suffix:
Gender:M
Credentials:DDS, PHD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 UNIVERSITY ST STE 820
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-4117
Mailing Address - Country:US
Mailing Address - Phone:206-467-8302
Mailing Address - Fax:206-467-8304
Practice Address - Street 1:600 UNIVERSITY ST STE 820
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-4117
Practice Address - Country:US
Practice Address - Phone:206-467-8302
Practice Address - Fax:206-467-8304
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE603791511223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics