Provider Demographics
NPI:1164674859
Name:IMOTO, CARRIE AKEMI (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:AKEMI
Last Name:IMOTO
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18740 VIKINGS WAY
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6169
Mailing Address - Country:US
Mailing Address - Phone:310-801-8010
Mailing Address - Fax:
Practice Address - Street 1:3511 MADISON ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-3739
Practice Address - Country:US
Practice Address - Phone:310-801-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA539121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics