Individual
WAYNE K. TANAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11092 UNIVERSITY CT RM 3306, LOMA LINDA, CA 92350-0001
(909) 558-4671
(909) 558-0285
Mailing address
11092 UNIVERSITY CT RM 3306, LOMA LINDA, CA 92350-0001
(909) 558-4671
(909) 558-0285
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
51201
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00SP18300
—
CA
05
—
GR0079700
—
CA
Enumeration date
01/12/2007
Last updated
07/09/2007
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