Provider Demographics
NPI:1487082426
Name:OKAMOTO, MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:OKAMOTO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22330 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2536
Mailing Address - Country:US
Mailing Address - Phone:310-373-1120
Mailing Address - Fax:310-373-1113
Practice Address - Street 1:22330 HAWTHORNE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2536
Practice Address - Country:US
Practice Address - Phone:310-373-1120
Practice Address - Fax:310-373-1113
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA627031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice