Individual
MELVIN H TAKAKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2008 SAINT MICHAELS DR, #B, SANTA FE, NM 87505-7682
(505) 474-4993
Mailing address
415 N GRAND AVE, PUEBLO, CO 81003-3111
(719) 583-1800
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD2104
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0009883
DORAL
NM
01
—
912997
UNITED CONCORDIA
NM
05
—
B5023
—
NM
Enumeration date
11/21/2006
Last updated
07/09/2007
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