Provider Demographics
NPI:1205658994
Name:TAKEMOTO, CLAUDINE TERUKO (RDH AP)
Entity type:Individual
Prefix:MR
First Name:CLAUDINE
Middle Name:TERUKO
Last Name:TAKEMOTO
Suffix:
Gender:F
Credentials:RDH AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6119 ARMITOS DR
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-9365
Mailing Address - Country:US
Mailing Address - Phone:805-616-8661
Mailing Address - Fax:
Practice Address - Street 1:6119 ARMITOS DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-9365
Practice Address - Country:US
Practice Address - Phone:805-616-8661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16326124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist