Provider Demographics
NPI:1013010420
Name:TAKESHITA, CRAIG YOSHIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:YOSHIO
Last Name:TAKESHITA
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 1:10945 SOUTH ST
Mailing Address - Street 2:STE 105A
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703
Mailing Address - Country:US
Mailing Address - Phone:562-924-7769
Mailing Address - Fax:562-924-7760
Practice Address - Street 1:10945 SOUTH ST
Practice Address - Street 2:STE 105A
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703
Practice Address - Country:US
Practice Address - Phone:562-924-7769
Practice Address - Fax:562-924-7760
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA336731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB3367301OtherDENTI CAL