Provider Demographics
NPI:1376761460
Name:VICKI E. OKAMOTO, D.D.S., M.S., INC.
Entity Type:Organization
Organization Name:VICKI E. OKAMOTO, D.D.S., M.S., INC.
Other - Org Name:OKAMOTO ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:E
Authorized Official - Last Name:OKAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:714-546-5170
Mailing Address - Street 1:1530 BAKER ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3752
Mailing Address - Country:US
Mailing Address - Phone:714-546-5170
Mailing Address - Fax:714-546-9411
Practice Address - Street 1:1530 BAKER ST
Practice Address - Street 2:SUITE C
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3752
Practice Address - Country:US
Practice Address - Phone:714-546-5170
Practice Address - Fax:714-546-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA415031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty