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General NPI Number Information
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NPI Number | 1447380928
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Entity Type | Organization
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Legal Business Name | FUMIO SHIBATA DDS A PROFESSIONAL CORP
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2200 LARKSPUR LANDING CIRCLE SUITE 103
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City | LARKSPUR
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State | CA
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Zip | 94939
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Country | US
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Telephone | 415-608-7823
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4447
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City | SAN RAFAEL
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State | CA
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Zip | 94913-4447
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Country | US
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Telephone | 415-608-7823
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FUMIO SHIBATA
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Credential | DDS
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Telephone | 415-608-7823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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