Provider Demographics
NPI:1003038019
Name:KUJIRAOKA, MARK ATSUSHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ATSUSHI
Last Name:KUJIRAOKA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11361 SUTTERS MILL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:GOLD RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95670
Mailing Address - Country:US
Mailing Address - Phone:916-635-0829
Mailing Address - Fax:916-635-1059
Practice Address - Street 1:2821 EASTERN AVENUE
Practice Address - Street 2:SUITE #2
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821
Practice Address - Country:US
Practice Address - Phone:916-483-7459
Practice Address - Fax:916-483-0604
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADB0346251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice