Individual
PROF. TAKASHI KOYAMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD, PHD FACS
Contact information
Practice address
2402 FRIST BLVD STE 100, FORT PIERCE, FL 34950-4838
(772) 461-9700
(772) 461-9300
Mailing address
2402 FRIST BLVD STE 100, FORT PIERCE, FL 34950-4838
(772) 461-9700
(772) 461-9300
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN16376
FL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
DN16376
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DN 16376
MEDICAL LICENSE
FL
Enumeration date
08/25/2006
Last updated
07/16/2019
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us