Provider Demographics
NPI:1336373075
Name:OSADA, TATSUHIKO (DDS)
Entity Type:Individual
Prefix:DR
First Name:TATSUHIKO
Middle Name:
Last Name:OSADA
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 1:3460 14TH ST NW APT 227
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-4400
Mailing Address - Country:US
Mailing Address - Phone:443-253-8993
Mailing Address - Fax:
Practice Address - Street 1:3020 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-6865
Practice Address - Country:US
Practice Address - Phone:443-253-8993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-10
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
DCDEN1000890122300000X
MD14410122300000X
VA0401412789122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program