Provider Demographics
NPI:1275670077
Name:TAKAHASHI, GEORGE YOICHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:YOICHI
Last Name:TAKAHASHI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 ESTUDILLO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4702
Mailing Address - Country:US
Mailing Address - Phone:510-483-5111
Mailing Address - Fax:510-483-9793
Practice Address - Street 1:345 ESTUDILLO AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4702
Practice Address - Country:US
Practice Address - Phone:510-483-5111
Practice Address - Fax:510-483-9793
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD157891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery