Provider Demographics
NPI:1942227665
Name:KOYAMA, DANIELA MIKIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:MIKIE
Last Name:KOYAMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 361009
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-1009
Mailing Address - Country:US
Mailing Address - Phone:787-966-7375
Mailing Address - Fax:
Practice Address - Street 1:817 AVE SAN PATRICIO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1311
Practice Address - Country:US
Practice Address - Phone:787-781-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice