Michael J Miyamoto, D.D.S., M.S.D.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DE60904232 Issued in WA

Practice address

24837 104TH Ave SE Ste 200
Kent, WA 98030-6800

Phone

(253) 850-1234

NPI assigned

Dec 13, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Washington Dental Corporation, PC

  • Dentist
  • Gig Harbor, WA
  • NPI 1912321597
  NPD (past)

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

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552867200000",
    "number": "1720356124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24837 104TH AVE SE STE 200",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980306800",
            "telephone_number": "253-850-1234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24837 104TH AVE SE STE 200",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980306800",
            "telephone_number": "253-850-1234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4901 Point Fosdick Dr NW Ste 300",
            "address_purpose": "LOCATION",
            "city": "Gig Harbor",
            "state": "WA",
            "postal_code": "983351846",
            "country_code": "US",
            "telephone_number": "253-858-8020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MIYAMOTO",
        "first_name": "MICHAEL",
        "middle_name": "J",
        "credential": "D.D.S., M.S.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-13",
        "last_updated": "2019-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WA",
            "license": "DE60904232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kishia Mitchell, LPN
• Raina Nicole Mitchell, LMP
• Thomas L. Mitchell, O.D.
• Hannah Mitiku, SLP
• Ashley Kayren-Walters Mixon
• Warda Moallim
• Roman Mochylo
• Ayan Mohamed
• Hilal Mohamed
• Kadra A Mohamed I, RN

• Orthodontics and Dentofacial Orthopedics Dentistry in Kent, WA
• Providers in Kent, WA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.