Provider Demographics
NPI:1548269194
Name:TANAKA, RANDALL T (DDS)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:T
Last Name:TANAKA
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 1:5449C SYCUAN RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-1821
Mailing Address - Country:US
Mailing Address - Phone:619-445-0707
Mailing Address - Fax:619-445-5419
Practice Address - Street 1:5449C SYCUAN RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-1821
Practice Address - Country:US
Practice Address - Phone:619-445-0707
Practice Address - Fax:619-445-5419
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38928122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist