MEDICARE: DANIEL KENJI FUNABASHI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0306	NC
2	122300000X	Dentist	85138875	WI

General Provider Information

NPI Number	:	1972305159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL KENJI FUNABASHI DDS

Provider Business Mailing Address
First Line	:	1851 MACGREGOR DOWNS RD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5925
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1851 MACGREGOR DOWNS RD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-5925
Country	:	US
Telephone Number	:	252-737-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/26/2025
Last Update Date	:	12/02/2025

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