Provider Demographics
NPI:1063779841
Name:ALAN P KAWAKAMI DDS PC
Entity type:Organization
Organization Name:ALAN P KAWAKAMI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KAWAKAMI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-459-1600
Mailing Address - Street 1:2700 E FRY BLVD
Mailing Address - Street 2:SUITE B-9
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-2826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 E FRY BLVD
Practice Address - Street 2:SUITE B-9
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2826
Practice Address - Country:US
Practice Address - Phone:520-459-1600
Practice Address - Fax:520-459-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2044261QD0000X, 1223G0001X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment