Provider Demographics
NPI:1346255734
Name:FUJIOKA, THEODORE MASARU (DMD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:MASARU
Last Name:FUJIOKA
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 1:215 NW 78TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-7972
Mailing Address - Country:US
Mailing Address - Phone:360-696-4439
Mailing Address - Fax:360-696-4455
Practice Address - Street 1:215 NW 78TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-7972
Practice Address - Country:US
Practice Address - Phone:360-696-4439
Practice Address - Fax:360-696-4455
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA38041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice