MEDICARE: DENNIS K KUWAYE JR DDS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	63550	CA

General Provider Information

NPI Number	:	1114460557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENNIS K KUWAYE JR DDS INC

Provider Business Mailing Address
First Line	:	2533 VIA CAMPO
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-1806
Country	:	US
Telephone Number	:	323-721-7401
Fax Number	:

Provider Business Practice Location Address
First Line	:	2533 VIA CAMPO
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-1806
Country	:	US
Telephone Number	:	323-721-7401
Fax Number	:

Authorized Official
Title or Position	:	DR
Name	:	DR. DENNIS K KUWAYE JR.
Credential	:	DDS
Telephone Number	:	323-721-7401

Provider Enumeration Date	:	12/01/2016
Last Update Date	:	12/01/2016

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