Provider Demographics
NPI:1083373245
Name:OKUDA ORTHODONTICS, PLLC
Entity Type:Organization
Organization Name:OKUDA ORTHODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRADY
Authorized Official - Middle Name:C
Authorized Official - Last Name:OKUDA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-737-5500
Mailing Address - Street 1:1701 N GREEN VALLEY PKWY STE 1
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5886
Mailing Address - Country:US
Mailing Address - Phone:702-737-5500
Mailing Address - Fax:702-737-5565
Practice Address - Street 1:1701 N GREEN VALLEY PKWY STE 1
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5886
Practice Address - Country:US
Practice Address - Phone:702-737-5500
Practice Address - Fax:702-737-5565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty