Provider Demographics
NPI:1659528982
Name:OSANAI, DAISUKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAISUKE
Middle Name:
Last Name:OSANAI
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 1:2129 31ST AVE
Mailing Address - Street 2:APT 1B
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-4521
Mailing Address - Country:US
Mailing Address - Phone:917-477-9209
Mailing Address - Fax:
Practice Address - Street 1:2129 31ST AVE
Practice Address - Street 2:APT 1B
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-4521
Practice Address - Country:US
Practice Address - Phone:917-477-9209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0523871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice