Provider Demographics
NPI:1336722156
Name:ROBERT TAKANO DDS
Entity Type:Organization
Organization Name:ROBERT TAKANO DDS
Other - Org Name:LA JOLLA HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRINCIPAL OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-209-5909
Mailing Address - Street 1:PO BOX 1333
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-7333
Mailing Address - Country:US
Mailing Address - Phone:858-209-5909
Mailing Address - Fax:
Practice Address - Street 1:13340 BARBADOS WAY
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3502
Practice Address - Country:US
Practice Address - Phone:858-209-5909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-29
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental