Glenn A. Takenaga, DDS, BS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

34907 Issued in CA

Practice address

3801 Pelandale Ave Ste B9
Modesto, CA 95356-8308

Phone

(209) 575-2400

Fax

(209) 575-0364

NPI assigned

Jan 25, 2008

Last updated

Jan 25, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Marinello Manuel Dental Corporation

  dba Sierra Dental Care

  • General Practice Dentistry
  • Modesto, CA
  • NPI 1457042145
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201219200000",
    "number": "1699952259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 PELANDALE AVE STE B-P",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953568300",
            "telephone_number": "209-575-2400",
            "fax_number": "209-575-0364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 PELANDALE AVE STE B9",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953568308",
            "telephone_number": "209-575-2400",
            "fax_number": "209-575-0364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAKENAGA",
        "first_name": "GLENN",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "DDS, BS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-01-25",
        "last_updated": "2008-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "34907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Negin Taher
• Paul Keng Taing
• Patricia Tajii
• Joan Tajon
• Takeflighttransportation
• Amanda Takke, PA-C
• La Tanya Alicia Takla, EDD, LMFT, LPCC
• Virginia Tifuh Taku, NP
• Evangelina A Talaro
• Benjamin Martin Talbott

• General Practice Dentistry in Modesto, CA
• Providers in Modesto, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.