Provider Demographics
NPI:1437246154
Name:SAKAMOTO, FRED OSAMU (DDS)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:OSAMU
Last Name:SAKAMOTO
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 1:3060 LEWIS CENTER RD
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-9207
Mailing Address - Country:US
Mailing Address - Phone:740-548-4622
Mailing Address - Fax:740-548-2338
Practice Address - Street 1:7334 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9239
Practice Address - Country:US
Practice Address - Phone:614-575-0070
Practice Address - Fax:614-575-0068
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300169511223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics