Provider Demographics
NPI:1659507432
Name:UENO, JEREMY KAORU (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:KAORU
Last Name:UENO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S BASCOM AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-3294
Mailing Address - Country:US
Mailing Address - Phone:408-371-7616
Mailing Address - Fax:408-371-7651
Practice Address - Street 1:2160 S BASCOM AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-3294
Practice Address - Country:US
Practice Address - Phone:408-371-7616
Practice Address - Fax:408-371-7651
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-06
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA583081223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics