Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Prof. Takashi Koyama, DMD, PHDFACS

Individual provider Oral and Maxillofacial Surgery (Dentist) · NPI 1356459028

Prof. Takashi Koyama, DMD, PHDFACS is an Oral Surgery in Fort Pierce, Florida. Graduated from Perelman School of Med at the University of Pennsylvania in 2000, 26 years ago. Accepts Medicare assignment. Licensed in Florida.

Years since qualifying
26
Trained at
Perelman School of Med at the University of Pennsylvania
Licensed in
FL
In the registry since
2006
Specialties on file
2
What do these letters mean?
DMD — Doctor of Dental Medicine
A dentist. Identical training and licensing to a DDS.

See every abbreviation used in this directory →

Practice location Address checks out

2402 Frist Blvd Ste 100
Fort Pierce, FL 34950-4838
Phone: (772) 461-9700
Fax: (772) 461-9300
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Oral & Maxillofacial Surgery (D.M.D.) (primary) Taxonomy 204E00000X · Licence DN16376 (FL)
Oral and Maxillofacial Surgery (Dentist) Taxonomy 1223S0112X · Licence DN16376 (FL)

Record details

NPI number1356459028
Entity typeIndividual (Type 1)
GenderMale
Credentials DMD , PHDFACS
Sole proprietorNo
NPI enumeratedAugust 25, 2006
Last updated in NPPESJuly 16, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyORAL SURGERY
Also practisesMAXILLOFACIAL SURGERY
Medical schoolPERELMAN SCHOOL OF MED AT THE UNIVERSITY OF PENNSYLVANIA
Graduated 2000 (26 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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