Provider Demographics
NPI:1992871701
Name:IKEDA, JANICE REIKO (DDS)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:REIKO
Last Name:IKEDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 128TH ST SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-6315
Mailing Address - Country:US
Mailing Address - Phone:425-290-6967
Mailing Address - Fax:425-290-6739
Practice Address - Street 1:927 128TH ST SW
Practice Address - Street 2:SUITE A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6315
Practice Address - Country:US
Practice Address - Phone:425-290-6967
Practice Address - Fax:425-290-6739
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist