Provider Demographics
NPI:1154861193
Name:KANEKO, TOMOYUKI (DDS,)
Entity Type:Individual
Prefix:DR
First Name:TOMOYUKI
Middle Name:
Last Name:KANEKO
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 1:813- 2 KAMISEDO
Mailing Address - Street 2:APT RYU101
Mailing Address - City:CHATAN
Mailing Address - State:OKINAWA
Mailing Address - Zip Code:9040101
Mailing Address - Country:JP
Mailing Address - Phone:098-989-3780
Mailing Address - Fax:
Practice Address - Street 1:813-2 KAMISEDO
Practice Address - Street 2:RYU101
Practice Address - City:CHATAN
Practice Address - State:OKINAWA
Practice Address - Zip Code:9040101
Practice Address - Country:JP
Practice Address - Phone:098-989-3780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ135201122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist