Provider Demographics
NPI:1467654855
Name:KONDO, GERALD TADAO (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:TADAO
Last Name:KONDO
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 1:390 SOUTH GREEN VALLEY ROAD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076
Mailing Address - Country:US
Mailing Address - Phone:831-728-1322
Mailing Address - Fax:831-728-2778
Practice Address - Street 1:390 SOUTH GREEN VALLEY ROAD
Practice Address - Street 2:SUITE #2
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076
Practice Address - Country:US
Practice Address - Phone:831-728-1322
Practice Address - Fax:831-728-2778
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26664122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice