Provider Demographics
NPI:1629210182
Name:HATAKEYAMA, TAKAYO (DMD)
Entity Type:Individual
Prefix:
First Name:TAKAYO
Middle Name:
Last Name:HATAKEYAMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E 48TH ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-1509
Mailing Address - Country:US
Mailing Address - Phone:212-486-8670
Mailing Address - Fax:347-427-2649
Practice Address - Street 1:230 E 48TH ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1509
Practice Address - Country:US
Practice Address - Phone:212-486-8670
Practice Address - Fax:347-427-2649
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0420901223P0300X
MD138291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics