Provider Demographics
NPI:1689794935
Name:SASAKI, GREG K (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:K
Last Name:SASAKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 W 155TH ST
Mailing Address - Street 2:SUITE #207
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4061
Mailing Address - Country:US
Mailing Address - Phone:310-329-7579
Mailing Address - Fax:310-329-0467
Practice Address - Street 1:1300 W 155TH ST
Practice Address - Street 2:SUITE #207
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4061
Practice Address - Country:US
Practice Address - Phone:310-329-7579
Practice Address - Fax:310-329-0467
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA327621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice