Basic Information
| Provider Information | |||||||||
| NPI: | 1154300846 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FURUKAWA | ||||||||
| FirstName: | KARL | ||||||||
| MiddleName: | KIYOTAKA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 51005 WINANS RILEY BARRACKS EAST WING | ||||||||
| Address2: | U.S. ARMY DENTAL ACTIVITY | ||||||||
| City: | FORT HUACHUCA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856137040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205333144 | ||||||||
| FaxNumber: | 5206242966 | ||||||||
| Practice Location | |||||||||
| Address1: | 2240 E WINROW AVE | ||||||||
| Address2: | U.S. ARMY DENTAL ACTIVITY | ||||||||
| City: | FORT HUACHUCA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856137040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205333144 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2006 | ||||||||
| LastUpdateDate: | 06/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0700X | DE00005568 | WA | Y | Dental Providers | Dentist | Prosthodontics |
No ID Information.