Provider Demographics
NPI:1003264938
Name:RONALD YUKIO WAKE, DDS, INC.
Entity Type:Organization
Organization Name:RONALD YUKIO WAKE, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:YUKIO
Authorized Official - Last Name:WAKE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-283-0280
Mailing Address - Street 1:895 MORAGA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5046
Mailing Address - Country:US
Mailing Address - Phone:925-283-0280
Mailing Address - Fax:925-283-0299
Practice Address - Street 1:895 MORAGA RD STE 2
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-5046
Practice Address - Country:US
Practice Address - Phone:925-283-0280
Practice Address - Fax:925-283-0299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA229311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty