Provider Demographics
NPI:1679698237
Name:SHIMIZU, DON K (DDS)
Entity type:Individual
Prefix:
First Name:DON
Middle Name:K
Last Name:SHIMIZU
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 1:3147 PUTNAM BLVD
Mailing Address - Street 2:STE. B
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4686
Mailing Address - Country:US
Mailing Address - Phone:925-934-8668
Mailing Address - Fax:925-934-4540
Practice Address - Street 1:3147 PUTNAM BLVD
Practice Address - Street 2:STE. B
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4686
Practice Address - Country:US
Practice Address - Phone:925-934-8668
Practice Address - Fax:925-934-4540
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice