MEDICARE: DR. RENEE KAMEKO TANABE DDS

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	122300000X	Dentist	61170	CA

General Provider Information

NPI Number	:	1578836706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENEE KAMEKO TANABE DDS

Provider Business Mailing Address
First Line	:	9900 LARKIN RD
Second Line	:
City	:	LIVE OAK
State	:	CA
Zip	:	95953-2442
Country	:	US
Telephone Number	:	530-695-1884
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 LARKIN RD
Second Line	:
City	:	LIVE OAK
State	:	CA
Zip	:	95953-2442
Country	:	US
Telephone Number	:	530-695-1884
Fax Number	:

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

Provider Enumeration Date	:	02/19/2012
Last Update Date	:	08/29/2017

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