Provider Demographics
NPI:1295957918
Name:GEOFFREY T. OKADA, A PROFESSIONAL DENTAL CORPORATION
Entity type:Organization
Organization Name:GEOFFREY T. OKADA, A PROFESSIONAL DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:TOSHIO
Authorized Official - Last Name:OKADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:818-843-0668
Mailing Address - Street 1:2701 W ALAMEDA AVE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4402
Mailing Address - Country:US
Mailing Address - Phone:818-843-0668
Mailing Address - Fax:818-843-0768
Practice Address - Street 1:2701 W ALAMEDA AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4402
Practice Address - Country:US
Practice Address - Phone:818-843-0668
Practice Address - Fax:818-843-0768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty