Provider Demographics
NPI:1194925263
Name:KANEGAWA, JON M (DDS)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:M
Last Name:KANEGAWA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4462 BOYERTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606
Mailing Address - Country:US
Mailing Address - Phone:610-779-7766
Mailing Address - Fax:610-779-7767
Practice Address - Street 1:4462 BOYERTOWN PIKE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606
Practice Address - Country:US
Practice Address - Phone:610-779-7766
Practice Address - Fax:610-779-7767
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023762L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist