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Organization
IAN IWANE DDS
Active
Organization
IAN IWANE DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IAN MICHIO IWANE DDS (OWNER)
(415) 845-0217
Entity
Organization
Contact information
Practice address
1536 BLAKE ST, NONE, BERKELEY, CA 94703-1806
(415) 845-0217
Mailing address
1536 BLAKE ST, NONE, BERKELEY, CA 94703-1806
(415) 845-0217
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
52870
CA
Other
Enumeration date
06/30/2014
Last updated
06/30/2014
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