Provider Demographics
NPI:1972743458
Name:MIYASAKI, MICHAEL ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:MIYASAKI
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 1:1428 U STREET
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-1489
Mailing Address - Country:US
Mailing Address - Phone:916-747-3038
Mailing Address - Fax:702-478-6469
Practice Address - Street 1:1428 U STREET
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-1489
Practice Address - Country:US
Practice Address - Phone:916-442-8911
Practice Address - Fax:702-478-6469
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA354331223D0001X, 1223G0001X
NV37831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health