Provider Demographics
NPI:1649428707
Name:OKAMOTO, YUTAKA (DDS)
Entity type:Individual
Prefix:
First Name:YUTAKA
Middle Name:
Last Name:OKAMOTO
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 1:5230 TUCKERMAN LN
Mailing Address - Street 2:SUITE 105
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3474
Mailing Address - Country:US
Mailing Address - Phone:240-667-7705
Mailing Address - Fax:
Practice Address - Street 1:5230 TUCKERMAN LN
Practice Address - Street 2:SUITE 105
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3474
Practice Address - Country:US
Practice Address - Phone:240-667-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13735122300000X, 1223G0001X, 122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
No122400000XDental ProvidersDenturist