PROF. TAKASHI KOYAMA (NPI# 1356459028) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356459028 |
| Entity Type | Individual |
| Full Name | PROF. TAKASHI KOYAMA |
| Credential | DMD, PHD FACS |
| Practice Address |
2402 Frist Blvd Ste 100 Fort Pierce FL 34950-4838 |
| Practice Telephone | 7724619700 |
| Practice Fax Number | 7724619300 |
| Mailing Telephone | 7724619700 |
| Mailing Fax Number | 7724619300 |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2019-07-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DN16376 | FL | Dental Providers |
| Y | 204E00000X | Oral & Maxillofacial Surgery | DN16376 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | MEDICAL LICENSE | DN 16376 | 01 |
| Street Address |
2402 FRIST BLVD STE 100 |
| City | FORT PIERCE |
| State | FL |
| Zip Code | 34950-4838 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558429753 | Takashi Koyama Dmd Phd Facs | Dentist | 2402 Frist Blvd Ste 100, Fort Pierce, FL 34950-4838 | 2006-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659853018 | New Day Counseling & Wellness, LLC | Clinic/Center | 130 S Indian River Drive Suite 202, Fort Pierce, FL 34950 | 2018-09-03 |
| 1548749351 | Jaber's Pharmacy, Inc. | Pharmacy | 2210 Orange Ave, Fort Pierce, FL 34950 | 2018-08-13 |
| 1386139699 | Pas Substance Abuse, Inc. | Substance Abuse Rehabilitation Facility | 2017 Avenue D, Fort Pierce, FL 34950 | 2018-06-28 |
| 1629573134 | Southeastern Dme LLC | Durable Medical Equipment & Medical Supplies | 200 S Indian River Dr Ste 300, Fort Pierce, FL 34950 | 2018-03-27 |
| 1962903666 | Serenity Dme LLC | Durable Medical Equipment & Medical Supplies | 111 N 2nd St Ste 101, Fort Pierce, FL 34950 | 2018-02-27 |
| 1417463068 | Ryan Nippes | Counselor | 1302 N Lawnwood Cr, Suite B, Fort Pierce, FL 34950 | 2017-12-19 |
| 1639685282 | Valencia Worrell | Counselor | 1302 N Lswnwood Cr, Suite B, Fort Pierce, FL 34950 | 2017-12-19 |
| 1194173153 | Angel French | Massage Therapist | 101 North Us1, Suite 117, Fort Pierce, FL 34950 | 2016-06-01 |
| 1780052951 | Alison Hess | Physician Assistant | 1700 S. 23rd St, Fort Pierce, FL 34950 | 2015-09-04 |
| 1629329784 | Dr. Rhaina A Smeds, Psyd Inc. | Psychologist | 100 Ave A, Ste 2d, Ft. Pierce, FL 34950 | 2012-09-28 |
| Find all providers in zip 34950 | ||||
| Taxonomy Code | 204E00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Oral & Maxillofacial Surgery |
| Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. |
| Notes: Source: American College of Surgeons, 2013. www.facs.org [7/1/2013: definition added, source added, additional resources added] Additional Resources: American Board of Oral and Maxillofacial Surgery and American Association of Oral and Maxillofacial Surgeons While this is generally considered a specialty of dentistry, physicians can also be board certified as oral and maxillofacial surgeons through the American Board of Oral and Maxillofacial Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730747395 | Michael A. Pikos, Dds Pa | Oral & Maxillofacial Surgery | 11940 Sheldon Road, Tampa, FL 33626 | 2019-05-30 |
| 1447625579 | Michael M Hashemian Dmd Md Pa | Oral & Maxillofacial Surgery | 32 Seven Hills Dr, Spring Hill, FL 34609-0212 | 2015-12-01 |
| 1629486097 | Oral Surgery Associates | Oral & Maxillofacial Surgery | 195 W Highland Street, Altamonte Springs, FL 32714 | 2014-07-29 |
| 1356601249 | First Coast Oral & Facial Surgery, Pa | Oral & Maxillofacial Surgery | 319 W Town Place, Suite 2, St Augustine, FL 32092 | 2012-05-24 |
| 1043582331 | Scott E. Farber, Dds.,p.a | Oral & Maxillofacial Surgery | 5150 Curry Ford Rd, Orlando, FL 32812-8744 | 2012-02-01 |
| 1760613426 | Jason E. Portnof | Oral & Maxillofacial Surgery | 9980 Central Park Blvd N Ste 113, Boca Raton, FL 33428-1703 | 2009-07-29 |
| 1497984785 | Ricardo M Ortiz | Oral & Maxillofacial Surgery | 2929 Capital Medical Blvd, Tallahassee, FL 32308-4407 | 2009-07-08 |
| 1992983654 | Patricia Hornback Dmd | Oral & Maxillofacial Surgery | 2426 Jenks Ave, Panama City, FL 32405-4908 | 2008-02-05 |
| 1821290305 | Marvin Craig Diamond | Oral & Maxillofacial Surgery | 5521 Bilbao Pl, Sarasota, FL 34238-4708 | 2007-06-05 |
| 1912048240 | Facial Surgery Center Pa | Oral & Maxillofacial Surgery | 1371 Bedford Drive, Melbourne, FL 32940 | 2007-02-09 |
| Find all providers with the same taxonomy | ||||
| City | FORT PIERCE |
| Zip Code | 34950 |
Please comment or provide details below to improve the information on PROF. TAKASHI KOYAMA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.