Provider Demographics
NPI:1710195599
Name:OZAKI, MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:OZAKI
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 1:14241 IMPERIAL HWY
Mailing Address - Street 2:SUITE M
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-1952
Mailing Address - Country:US
Mailing Address - Phone:562-941-2201
Mailing Address - Fax:
Practice Address - Street 1:14241 IMPERIAL HWY
Practice Address - Street 2:SUITE M
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1952
Practice Address - Country:US
Practice Address - Phone:562-941-2201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA316821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice