MEDICARE: DR. NICOLE KIKUE FURUTA 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	54716	CA

General Provider Information

NPI Number	:	1245368596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLE KIKUE FURUTA DDS

Provider Business Mailing Address
First Line	:	1435 WAZEE ST STE 102
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1491
Country	:	US
Telephone Number	:	303-623-5636
Fax Number	:	303-623-5640

Provider Business Practice Location Address
First Line	:	1435 WAZEE ST STE 102
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80202-1491
Country	:	US
Telephone Number	:	303-623-5636
Fax Number	:	303-623-5640

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	04/28/2023

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