MEDICARE: LUKE H IWATA D.D.S.

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	1223G0001X	General Practice Dentistry	26870	CA

General Provider Information

NPI Number	:	1578561106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE H IWATA D.D.S.

Provider Business Mailing Address
First Line	:	11285 MOUNTAIN VIEW AVE
Second Line	:	SUITE H-32
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3862
Country	:	US
Telephone Number	:	909-796-6447
Fax Number	:	909-558-3092

Provider Business Practice Location Address
First Line	:	11285 MOUNTAIN VIEW AVE
Second Line	:	SUITE H-32
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3862
Country	:	US
Telephone Number	:	909-796-6447
Fax Number	:	909-558-3092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/08/2007

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