Provider Demographics
NPI:1831228220
Name:YAMAMOTO, TAKEO (DDS)
Entity type:Individual
Prefix:DR
First Name:TAKEO
Middle Name:
Last Name:YAMAMOTO
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 1:1200 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD206051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice