Provider Demographics
NPI:1306408091
Name:SAKAMOTO, MASAKI
Entity Type:Individual
Prefix:
First Name:MASAKI
Middle Name:
Last Name:SAKAMOTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10212 5TH AVE NE STE 268
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7495
Mailing Address - Country:US
Mailing Address - Phone:206-527-5111
Mailing Address - Fax:
Practice Address - Street 1:10212 5TH AVE NE STE 268
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7495
Practice Address - Country:US
Practice Address - Phone:206-527-5111
Practice Address - Fax:206-527-1013
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2020-08-17
Deactivation Date:2019-09-07
Deactivation Code:
Reactivation Date:2020-08-12
Provider Licenses
StateLicense IDTaxonomies
FLDN24413122300000X
WADE60977067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist