Provider Demographics
NPI:1124050208
Name:MIYAKE, ALAN AKIO (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:AKIO
Last Name:MIYAKE
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N. STONEWALL AVE. DCSB 206
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73117-1214
Mailing Address - Country:US
Mailing Address - Phone:405-271-4441
Mailing Address - Fax:405-271-1134
Practice Address - Street 1:1201 N. STONEWALL AVE DCSB 206
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73117-1214
Practice Address - Country:US
Practice Address - Phone:405-271-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22636204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK22636OtherMEDICAL LICENSE #
OK5578OtherDENTAL LICENSE #
OK22636OtherMEDICAL LICENSE #