Provider Demographics
NPI:1609892421
Name:FUJITA, DANA KIYOMI (DDS)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:KIYOMI
Last Name:FUJITA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 8TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-4973
Mailing Address - Country:US
Mailing Address - Phone:970-761-2056
Mailing Address - Fax:970-761-2062
Practice Address - Street 1:116 8TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-4973
Practice Address - Country:US
Practice Address - Phone:970-761-2056
Practice Address - Fax:970-761-2062
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO84921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06302815Medicaid