Provider Demographics
NPI:1245359918
Name:TAKEO YAMAMOTO, DDS INC.
Entity type:Organization
Organization Name:TAKEO YAMAMOTO, DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAKEO
Authorized Official - Middle Name:
Authorized Official - Last Name:YAMAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-241-1714
Mailing Address - Street 1:1200 N TUSTIN AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3508
Mailing Address - Country:US
Mailing Address - Phone:714-241-1714
Mailing Address - Fax:714-241-1031
Practice Address - Street 1:1200 N TUSTIN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-3508
Practice Address - Country:US
Practice Address - Phone:714-241-1714
Practice Address - Fax:714-241-1031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD20605122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty