Provider Demographics
NPI:1568028736
Name:HONDA, KERI MICHELLE
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:MICHELLE
Last Name:HONDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7104 N FRESNO ST STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2970
Mailing Address - Country:US
Mailing Address - Phone:559-439-2147
Mailing Address - Fax:
Practice Address - Street 1:7104 N FRESNO ST STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2970
Practice Address - Country:US
Practice Address - Phone:559-439-2147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant