Koyama, Takashi
Koyama, Takashi is an individual health care provider with primary practice located at 2402 Frist Blvd Ste 100 , Fort Pierce FL 34950-4838. He recently has 2 registered licenses in different health care specialties including Dental Providers / Oral and Maxillofacial Surgery, Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery. Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery is his primary health care specialty. Koyama, Takashi can be contacted via phone (772) 461-9700.Contact Information
Primary practice address
2402 Frist Blvd Ste 100
Fort Pierce FL 34950-4838
Phone: (772) 461-9700
Fax: (772) 461-9300
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Dental Providers / Oral and Maxillofacial Surgery | 1223S0112X | DN16376 | Florida |
Allopathic & Osteopathic Physicians / Oral & Maxillofacial Surgery | 204E00000X | DN16376 | Florida |
Profile Details
NPI number | 1356459028 |
---|---|
LBN Legal business name | Koyama, Takashi |
Credentials | DMD, PHD FACS |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Aug 25th, 2006 |
Last updated | Jul 16th, 2019 - about 5 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1356459028 | NPPES |
Florida | Other | DN 16376 | MEDICAL LICENSE |
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