Provider Demographics
NPI:1952536963
Name:KUGA, MIKAKO (DDS)
Entity Type:Individual
Prefix:
First Name:MIKAKO
Middle Name:
Last Name:KUGA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 CALIFORNIA ST.
Mailing Address - Street 2:SUIT D
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373
Mailing Address - Country:US
Mailing Address - Phone:909-307-6453
Mailing Address - Fax:909-307-6089
Practice Address - Street 1:11201 CALIFORNIA ST.
Practice Address - Street 2:SUIT D
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-307-6453
Practice Address - Fax:909-307-6089
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41444122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist