Provider Demographics
NPI:1598701765
Name:TSUTSUSE, WAYNE KAZUMI (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:KAZUMI
Last Name:TSUTSUSE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 SUNCAST LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9335
Mailing Address - Country:US
Mailing Address - Phone:916-941-2447
Mailing Address - Fax:916-941-2466
Practice Address - Street 1:1020 SUNCAST LN
Practice Address - Street 2:SUITE 103
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9335
Practice Address - Country:US
Practice Address - Phone:916-941-2447
Practice Address - Fax:916-941-2466
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA265511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice