Provider Demographics
NPI:1447380928
Name:FUMIO SHIBATA DDS A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:FUMIO SHIBATA DDS A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FUMIO
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIBATA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-608-7823
Mailing Address - Street 1:PO BOX 4447
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94913-4447
Mailing Address - Country:US
Mailing Address - Phone:415-608-7823
Mailing Address - Fax:
Practice Address - Street 1:2200 LARKSPUR LANDING CIRCLE
Practice Address - Street 2:SUITE 103
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939
Practice Address - Country:US
Practice Address - Phone:415-608-7823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty