Provider Demographics
NPI:1073656773
Name:FUKUDA, FRANKLIN M (DMD)
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:M
Last Name:FUKUDA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 WAIALAE AVE STE 315
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5845
Mailing Address - Country:US
Mailing Address - Phone:808-737-7905
Mailing Address - Fax:808-737-7988
Practice Address - Street 1:3221 WAIALAE AVE STE 315
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5845
Practice Address - Country:US
Practice Address - Phone:808-737-7905
Practice Address - Fax:808-737-7988
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice