Provider Demographics
NPI:1134348477
Name:MIKURIYA, T SCOTT (DMD)
Entity type:Individual
Prefix:DR
First Name:T
Middle Name:SCOTT
Last Name:MIKURIYA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2275 W CARSON ST STE C
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-7129
Mailing Address - Country:US
Mailing Address - Phone:310-320-0444
Mailing Address - Fax:310-320-0445
Practice Address - Street 1:2275 W CARSON ST STE C
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-7129
Practice Address - Country:US
Practice Address - Phone:310-320-0444
Practice Address - Fax:310-320-0445
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33810122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist