Provider Demographics
NPI:1710744404
Name:ITO, RODNEY K (DDS, MS)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:K
Last Name:ITO
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 HEATHER RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5130
Mailing Address - Country:US
Mailing Address - Phone:925-216-5634
Mailing Address - Fax:
Practice Address - Street 1:946 W WINTON AVE
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1521
Practice Address - Country:US
Practice Address - Phone:510-785-1441
Practice Address - Fax:510-785-1468
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA334721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275542342OtherNPI TYPE II