Provider Demographics
NPI:1649488198
Name:IKUTA, FRANK LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:FRANK
Middle Name:LYNN
Last Name:IKUTA
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 1:1655 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654
Mailing Address - Country:US
Mailing Address - Phone:559-638-6808
Mailing Address - Fax:559-638-0160
Practice Address - Street 1:1655 8TH ST
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654-2602
Practice Address - Country:US
Practice Address - Phone:559-638-6808
Practice Address - Fax:559-638-0160
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA318031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice