Provider Demographics
NPI:1477090744
Name:STEVEN A MIYAMOTO, DDS, INC.
Entity Type:Organization
Organization Name:STEVEN A MIYAMOTO, DDS, INC.
Other - Org Name:FULLERTON ORAL SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIYAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-525-1178
Mailing Address - Street 1:113 W AMERIGE AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1856
Mailing Address - Country:US
Mailing Address - Phone:714-525-1178
Mailing Address - Fax:714-879-6235
Practice Address - Street 1:113 W AMERIGE AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1856
Practice Address - Country:US
Practice Address - Phone:714-525-1178
Practice Address - Fax:714-879-6235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA423681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty