Healthcare Provider Details

I. General information

NPI: 1336212778
Provider Name (Legal Business Name): WILLIAM TOSHIO FUTA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W TOWN AND COUNTRY RD SUITE 46
ORANGE CA
92868-4615
US

IV. Provider business mailing address

1111 W TOWN AND COUNTRY RD SUITE 46
ORANGE CA
92868-4615
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-4441
  • Fax: 714-835-0188
Mailing address:
  • Phone: 714-835-4441
  • Fax: 714-835-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number19882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: