Provider Demographics
NPI:1114948965
Name:FUKUDA, JAMES TOSHIO (DMD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:TOSHIO
Last Name:FUKUDA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:851 MAIN ST STE 3
Mailing Address - Street 2:NEVIN PROFESSIONAL BUILDING
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1613
Mailing Address - Country:US
Mailing Address - Phone:781-331-0140
Mailing Address - Fax:781-337-4700
Practice Address - Street 1:851 MAIN ST STE 3
Practice Address - Street 2:NEVIN PROFESSIONAL BUILDING
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1613
Practice Address - Country:US
Practice Address - Phone:781-331-0140
Practice Address - Fax:781-337-4700
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA195031223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry