Provider Demographics
NPI:1558557199
Name:UNTERNAHER, CARY BLAKE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARY
Middle Name:BLAKE
Last Name:UNTERNAHER
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 1:655 E HAWKEYE AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95380-7522
Mailing Address - Country:US
Mailing Address - Phone:209-667-6654
Mailing Address - Fax:209-667-0352
Practice Address - Street 1:655 E HAWKEYE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-7522
Practice Address - Country:US
Practice Address - Phone:209-667-6654
Practice Address - Fax:209-667-0352
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice