Provider Demographics
NPI:1366024424
Name:KOYAMA DENTAL LLC
Entity Type:Organization
Organization Name:KOYAMA DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOYAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:939-273-8750
Mailing Address - Street 1:PO BOX 361009
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-1009
Mailing Address - Country:US
Mailing Address - Phone:787-810-9911
Mailing Address - Fax:
Practice Address - Street 1:269 MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2530
Practice Address - Country:US
Practice Address - Phone:787-966-7375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-27
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty