Provider Demographics
NPI:1376659268
Name:SHIMOIDE, RONALD KENJI (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:KENJI
Last Name:SHIMOIDE
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 1:401 N BROOKHURST ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:714-635-8653
Mailing Address - Fax:714-635-2116
Practice Address - Street 1:401 N BROOKHURST ST
Practice Address - Street 2:SUITE 118
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-635-8653
Practice Address - Fax:714-635-2116
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA311811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice