Active NPI
Alan M Takaki, D.D.S.
- General Practice Dentistry
- Pueblo, CO
National Provider Identifier
1306822556
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 00126
- Practice address
- 1630 Fortino Blvd
Pueblo, CO 81008-1856 - Phone
- (719) 545-2468
- Fax
- (719) 545-0815
- NPI assigned
- Dec 20, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 00126 | CO | Primary |
Addresses
Primary practice location
1630 Fortino Blvd
Pueblo, CO 81008-1856
Mailing address
1630 Fortino Blvd
Pueblo, CO 81008-1856
Phone (719) 545-2468
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 722113 | Other | CO | UNITED CONCORDIA |
| 78325 | Other | CO | ANTHEM BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00126 | CO | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135036800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1200528000000",
"number": "1306822556",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1630 FORTINO BLVD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081856",
"telephone_number": "719-545-2468",
"fax_number": "719-545-0815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1630 FORTINO BLVD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810081856",
"telephone_number": "719-545-2468",
"fax_number": "719-545-0815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAKAKI",
"first_name": "ALAN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-20",
"last_updated": "2008-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CO",
"license": "00126",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "722113",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "78325",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.