Provider Demographics
NPI:1407008444
Name:OKAMOTO, BRIAN TATSUO (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:TATSUO
Last Name:OKAMOTO
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 1:4305 TORRANCE BOULEVARD.
Mailing Address - Street 2:SUITE 401
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4495
Mailing Address - Country:US
Mailing Address - Phone:310-370-2547
Mailing Address - Fax:310-370-2548
Practice Address - Street 1:4305 TORRANCE BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4409
Practice Address - Country:US
Practice Address - Phone:310-370-2547
Practice Address - Fax:310-370-2548
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35437122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist