Provider Demographics
NPI:1821172131
Name:KAWAKAMI, ALAN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:P
Last Name:KAWAKAMI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2700 E FRY BLVD
Mailing Address - Street 2:SUITE B-9
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2826
Mailing Address - Country:US
Mailing Address - Phone:520-459-1600
Mailing Address - Fax:520-459-5763
Practice Address - Street 1:2700 E FRY BLVD
Practice Address - Street 2:SUITE B-9
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2826
Practice Address - Country:US
Practice Address - Phone:520-459-1600
Practice Address - Fax:520-459-5763
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2044332BC3200X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment