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General NPI Number Information
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NPI Number | 1992242275
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Entity Type | Individual
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Provider Name | MIZUKI CHERYL TADOKORO D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 943 AVENIDA PICO SUITE A
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-3913
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Country | US
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Telephone | 714-785-2199
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Fax |
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Provider Business Mailing Address
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Address Line | 206 ALMADOR
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City | IRVINE
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State | CA
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Zip | 92614-8409
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Country | US
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Telephone | 714-785-2199
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 101055
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License Number State | CA
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