Provider Demographics
NPI:1568682151
Name:GREGORY H. KUWABARA, D.D.S., INC
Entity Type:Organization
Organization Name:GREGORY H. KUWABARA, D.D.S., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KUWABARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-986-1699
Mailing Address - Street 1:16960 BASTANCHURY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-1711
Mailing Address - Country:US
Mailing Address - Phone:714-986-1699
Mailing Address - Fax:714-986-1690
Practice Address - Street 1:16960 BASTANCHURY RD
Practice Address - Street 2:SUITE B
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-1711
Practice Address - Country:US
Practice Address - Phone:714-986-1699
Practice Address - Fax:714-986-1690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2012-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34455261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX ID