Provider Demographics
NPI:1205114501
Name:HIDEKI IKEDA D.D.S., M.S., DENTAL CORPORATION
Entity type:Organization
Organization Name:HIDEKI IKEDA D.D.S., M.S., DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HIDEKI
Authorized Official - Middle Name:
Authorized Official - Last Name:IKEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-893-7539
Mailing Address - Street 1:12777 VALLEY VIEW ST..
Mailing Address - Street 2:SUITE 222
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845
Mailing Address - Country:US
Mailing Address - Phone:714-893-7539
Mailing Address - Fax:714-893-6736
Practice Address - Street 1:12777 VALLEY VIEW ST..
Practice Address - Street 2:SUITE 222
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845
Practice Address - Country:US
Practice Address - Phone:714-893-7539
Practice Address - Fax:714-893-6736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty