Provider Demographics
NPI:1578836706
Name:TANABE, RENEE KAMEKO (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:KAMEKO
Last Name:TANABE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 LARKIN RD
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:CA
Mailing Address - Zip Code:95953-2442
Mailing Address - Country:US
Mailing Address - Phone:530-695-1884
Mailing Address - Fax:
Practice Address - Street 1:9900 LARKIN RD
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:CA
Practice Address - Zip Code:95953-2442
Practice Address - Country:US
Practice Address - Phone:530-695-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-19
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61170122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist