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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 7 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1356459028 NPPES
Florida Other DN 16376 MEDICAL LICENSE

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