Provider Demographics
NPI:1578577946
Name:MORIKADO, KENT K
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:K
Last Name:MORIKADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 E GOLF RD
Mailing Address - Street 2:205
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-4967
Mailing Address - Country:US
Mailing Address - Phone:847-593-6480
Mailing Address - Fax:
Practice Address - Street 1:637 E GOLF RD
Practice Address - Street 2:205
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-4967
Practice Address - Country:US
Practice Address - Phone:847-593-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice