Provider Demographics
NPI:1366888455
Name:OKINO, SCOTT TERAO (DDS)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:TERAO
Last Name:OKINO
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 1:670 NW GILMAN BLVD STE B3
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2444
Mailing Address - Country:US
Mailing Address - Phone:425-557-6453
Mailing Address - Fax:425-391-5556
Practice Address - Street 1:670 NW GILMAN BLVD STE B3
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2444
Practice Address - Country:US
Practice Address - Phone:425-557-6453
Practice Address - Fax:425-391-5556
Is Sole Proprietor?:No
Enumeration Date:2013-05-15
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008773122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist