Provider Demographics
NPI:1417294877
Name:KUNIYOSHI SHIMIZU DENTAL GROUP LLC
Entity Type:Organization
Organization Name:KUNIYOSHI SHIMIZU DENTAL GROUP LLC
Other - Org Name:KUNIYOSHI DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNIYOSHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:614-734-2700
Mailing Address - Street 1:5100 BRADENTON AVE
Mailing Address - Street 2:STE A
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-7567
Mailing Address - Country:US
Mailing Address - Phone:614-734-2700
Mailing Address - Fax:614-734-2702
Practice Address - Street 1:5100 BRADENTON AVE
Practice Address - Street 2:STE A
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7567
Practice Address - Country:US
Practice Address - Phone:614-734-2700
Practice Address - Fax:614-734-2702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.023685122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty