Provider Demographics
NPI:1669545752
Name:OKAMOTO, GARY U (DMD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:U
Last Name:OKAMOTO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77564 COUNTRY CLUB DR
Mailing Address - Street 2:#190A
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-0484
Mailing Address - Country:US
Mailing Address - Phone:760-360-0622
Mailing Address - Fax:760-360-6282
Practice Address - Street 1:77564 COUNTRY CLUB DR
Practice Address - Street 2:#190A
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-0484
Practice Address - Country:US
Practice Address - Phone:760-360-0622
Practice Address - Fax:760-360-6282
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345361223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry