Provider Demographics
NPI:1508198680
Name:KUNIMOTO DENTAL CORP
Entity Type:Organization
Organization Name:KUNIMOTO DENTAL CORP
Other - Org Name:BRITE DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:K
Authorized Official - Last Name:KUNIMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:209-478-7221
Mailing Address - Street 1:4661 PRECISSI LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-6206
Mailing Address - Country:US
Mailing Address - Phone:209-478-7221
Mailing Address - Fax:
Practice Address - Street 1:4661 PRECISSI LN
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-6206
Practice Address - Country:US
Practice Address - Phone:209-478-7221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA556691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty