Provider Demographics
NPI:1295831097
Name:HONDA, BLAINE ISAMU (DDS)
Entity Type:Individual
Prefix:DR
First Name:BLAINE
Middle Name:ISAMU
Last Name:HONDA
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 1:2020 HEARST AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-2130
Mailing Address - Country:US
Mailing Address - Phone:510-841-0662
Mailing Address - Fax:510-841-0917
Practice Address - Street 1:2020 HEARST AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-2130
Practice Address - Country:US
Practice Address - Phone:510-841-0662
Practice Address - Fax:510-841-0917
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA034454122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA034454OtherSTATE BOARD OF DENTAL EXA