Individual
KENTARO IKEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
150533
NC
122300000X
Dentist
Primary
AD.0000515
CO
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DF11935
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38820064
—
CO
Enumeration date
03/07/2007
Last updated
04/24/2026
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