Healthcare Provider Details

I. General information

NPI: 1083040349
Provider Name (Legal Business Name): KENT SHINOZAKI, DDS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 09/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 EAST RAND ROAD SUITE 200
ARLINGTON HEIGHTS IL
60004
US

IV. Provider business mailing address

304 EAST RAND ROAD SUITE 200
ARLINGTON HEIGHTS IL
60004
US

V. Phone/Fax

Practice location:
  • Phone: 224-770-3001
  • Fax:
Mailing address:
  • Phone: 224-770-3001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number019029262
License Number StateIL

VIII. Authorized Official

Name: DR. KENT SHINOZAKI
Title or Position: OWNER
Credential: D.D.S.
Phone: 224-770-3001