Healthcare Provider Details

I. General information

NPI: 1154300846
Provider Name (Legal Business Name): KARL KIYOTAKA FURUKAWA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 E WINROW AVE U.S. ARMY DENTAL ACTIVITY
FORT HUACHUCA AZ
85613-7040
US

IV. Provider business mailing address

51005 WINANS RILEY BARRACKS EAST WING U.S. ARMY DENTAL ACTIVITY
FORT HUACHUCA AZ
85613-7040
US

V. Phone/Fax

Practice location:
  • Phone: 520-533-3144
  • Fax:
Mailing address:
  • Phone: 520-533-3144
  • Fax: 520-624-2966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDE00005568
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: