Provider Demographics
NPI:1871867671
Name:TAKAMORI, ELIZABETH ANH SMITH (DDS, MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANH SMITH
Last Name:TAKAMORI
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 SKYLINE RD S
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97306-9427
Mailing Address - Country:US
Mailing Address - Phone:503-588-6506
Mailing Address - Fax:
Practice Address - Street 1:5135 SKYLINE RD S
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97306-9427
Practice Address - Country:US
Practice Address - Phone:503-588-6506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10165122300000X
CA60690122300000X
WADE60402594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist