Provider Demographics
NPI:1780771691
Name:SHINOZAKI, KENT M (DDS)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:M
Last Name:SHINOZAKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:304 EAST RAND ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004
Mailing Address - Country:US
Mailing Address - Phone:224-770-3001
Mailing Address - Fax:
Practice Address - Street 1:304 EAST RAND ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004
Practice Address - Country:US
Practice Address - Phone:224-770-3001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI22231223S0112X
CA529311223S0112X
IL0190292621223S0112X
WI6965-151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery