Provider Demographics
NPI:1871258061
Name:SHIZUOKA PLLC
Entity Type:Organization
Organization Name:SHIZUOKA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HIROSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-954-9339
Mailing Address - Street 1:1441 MIDLOTHIAN PKWY, STE 150
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065
Mailing Address - Country:US
Mailing Address - Phone:972-954-9339
Mailing Address - Fax:972-945-3040
Practice Address - Street 1:1441 MIDLOTHIAN PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065
Practice Address - Country:US
Practice Address - Phone:972-954-9339
Practice Address - Fax:972-945-3040
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHIZUOKA PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212955335Medicaid