Alan M Takaki Takaki Dental Care Center

Organization Active NPI General Practice Dentistry · Pueblo, CO

NPI 1841561024 · NPPES record last updated Jan 20, 2012

Key facts

NPI
1841561024
Entity type
Organization (NPI type 2)
Primary specialty
General Practice Dentistry 1223G0001X
License
126 (CO)
Legal business name
ALAN M TAKAKI TAKAKI DENTAL CARE CENTER
Practice address
1630 Fortino Blvd
Pueblo, CO 81008-1856
Phone
(719) 545-2468
Fax
(719) 545-0815
NPI assigned
Jan 20, 2012
Organization subpart
No

Authorized official

Name
Alan M Takaki, DDS
Title
Owner
Phone
(719) 545-2468

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry
Group: 193400000X SINGLE SPECIALTY GROUP
1223G0001X 126 CO Yes

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

IdentifierTypeStateIssuer
04015905MedicaidCO
810388OtherCOUNITED CONCORDIA

Other names

  • Takaki Dental Care Center Former legal business name

Other providers in Pueblo, CO

All providers in Pueblo, CO · General Practice Dentistry in Colorado

Sources for this page

Verify at the official NPI Registry.