Provider Demographics
NPI:1932214236
Name:WAKAMATSU, TOD HITOSHI (DDS)
Entity type:Individual
Prefix:DR
First Name:TOD
Middle Name:HITOSHI
Last Name:WAKAMATSU
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 EAST THIRD STREET
Mailing Address - Street 2:SUITE 702
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90013-1647
Mailing Address - Country:US
Mailing Address - Phone:213-626-0561
Mailing Address - Fax:213-626-0564
Practice Address - Street 1:420 EAST THIRD STREET
Practice Address - Street 2:SUITE 702
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90013-1647
Practice Address - Country:US
Practice Address - Phone:213-626-0561
Practice Address - Fax:213-626-0564
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39574122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist