Organization
ALAN M TAKAKI TAKAKI DENTAL CARE CENTER
Active
Other names
Takaki Dental Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
ALAN M TAKAKI DDS (OWNER)
(719) 545-2468
Entity
Organization
Contact information
Practice address
1630 FORTINO BLVD, PUEBLO, CO 81008-1856
(719) 545-2468
(719) 545-0815
Mailing address
1630 FORTINO BLVD, PUEBLO, CO 81008-1856
(719) 545-2468
(719) 545-0815
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
126
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04015905
—
CO
01
—
810388
UNITED CONCORDIA
CO
Enumeration date
01/20/2012
Last updated
01/20/2012
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