Provider Demographics
NPI:1902067747
Name:TACHIBANA, MIDORI BETTY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIDORI
Middle Name:BETTY
Last Name:TACHIBANA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 FRANKLIN ST
Mailing Address - Street 2:SUITE 1220
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-2897
Mailing Address - Country:US
Mailing Address - Phone:510-893-4041
Mailing Address - Fax:
Practice Address - Street 1:1624 FRANKLIN ST
Practice Address - Street 2:SUITE 1220
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-2897
Practice Address - Country:US
Practice Address - Phone:510-893-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2014-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS 549871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics