Individual
DR. TAKANARI MIYAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
12110 PORT GRACE BLVD STE 202, LA VISTA, NE 68128-3190
(402) 614-7022
(402) 614-7122
Mailing address
12110 PORT GRACE BLVD STE 202, LA VISTA, NE 68128-3190
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
6823
NE
Other
Enumeration date
09/26/2007
Last updated
05/27/2010
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