Provider Demographics
NPI:1760594659
Name:KANEMURA, GARY K (DDS)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:K
Last Name:KANEMURA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 TIENDA DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-3933
Mailing Address - Country:US
Mailing Address - Phone:209-333-2688
Mailing Address - Fax:209-333-2377
Practice Address - Street 1:1930 TIENDA DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-3933
Practice Address - Country:US
Practice Address - Phone:209-333-2688
Practice Address - Fax:209-333-2377
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299601223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics