Provider Demographics
NPI:1841619400
Name:TAKEDA, ALYSSA (DDS)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:TAKEDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 E SHEPHERD AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1662
Mailing Address - Country:US
Mailing Address - Phone:559-824-5350
Mailing Address - Fax:
Practice Address - Street 1:383 E SHEPHERD AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1662
Practice Address - Country:US
Practice Address - Phone:559-824-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program