Takashi Koyama DMD PHD PA

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

Legal business name

TAKASHI KOYAMA DMD PHD PA

Doing business as

Florida Institute of OMS

Practice address

2402 Frist Blvd Ste 100
Fort Pierce, FL 34950-4838

Phone

(772) 461-9700

Fax

(772) 461-9300

NPI assigned

Dec 4, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tanya Gonzalez

Title

Practice Manager

Phone

(772) 461-9700

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Florida Institute of OMS Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Takashi Koyama, DMD, PHD FACS

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Fort Pierce, FL
  • NPI 1356459028

  Oral and Maxillofacial Surgery

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706659200000",
    "number": "1558429753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2402 FRIST BLVD STE 100",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349504838",
            "telephone_number": "772-461-9700",
            "fax_number": "772-461-9300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2402 FRIST BLVD STE 100",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349504838",
            "telephone_number": "772-461-9700",
            "fax_number": "772-461-9300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAKASHI KOYAMA DMD PHD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-04",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "772-461-9700"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Oral & Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "DN 16376",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida Institute of OMS",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Florida Institute of OMS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Syed Shafeeq Ur Rahman PA
• Oszkar Szentirmai, MD
• Ehab Tadrous
• Marie Ann Taglione, M.S.
• Dolly Tailor, MD
• Edna Talabert, ARNP
• John Anthony Tallarido, LCSW
• Talquin Inc
• Jessica Tam, PTA
• Arielle Tango, FNP-C

• Oral & Maxillofacial Surgery (D.M.D.) in Fort Pierce, FL
• Providers in Fort Pierce, FL by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.