Provider Demographics
NPI:1740395979
Name:SAKO, TED (DDS)
Entity Type:Individual
Prefix:DR
First Name:TED
Middle Name:
Last Name:SAKO
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 1:4048 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:GROVES
Mailing Address - State:TX
Mailing Address - Zip Code:77619-4640
Mailing Address - Country:US
Mailing Address - Phone:409-962-2273
Mailing Address - Fax:
Practice Address - Street 1:4048 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:GROVES
Practice Address - State:TX
Practice Address - Zip Code:77619-4640
Practice Address - Country:US
Practice Address - Phone:409-962-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD154501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice