Provider Demographics
NPI:1134215650
Name:OKAMOTO, VICKI E (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:E
Last Name:OKAMOTO
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Gender:F
Credentials:DDS, MS
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Mailing Address - Street 1:1530 BAKER STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3752
Mailing Address - Country:US
Mailing Address - Phone:714-546-5170
Mailing Address - Fax:714-546-9411
Practice Address - Street 1:1530 BAKER STREET
Practice Address - Street 2:SUITE C
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-3752
Practice Address - Country:US
Practice Address - Phone:714-546-5170
Practice Address - Fax:714-546-9411
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA415031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics