Provider Demographics
NPI:1083827257
Name:DAIKI A. OTSUKA, DDS, PA
Entity Type:Organization
Organization Name:DAIKI A. OTSUKA, DDS, PA
Other - Org Name:PARKSIDE DENTAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:SUMIRE
Authorized Official - Last Name:OTSUKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-461-0130
Mailing Address - Street 1:1617 PARKER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-6950
Mailing Address - Country:US
Mailing Address - Phone:201-461-0130
Mailing Address - Fax:201-461-8525
Practice Address - Street 1:1617 PARKER AVE
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-6950
Practice Address - Country:US
Practice Address - Phone:201-461-0130
Practice Address - Fax:201-461-8525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty