Provider Demographics
NPI:1669457164
Name:KIMURA, TODD SHUJI (DDS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:SHUJI
Last Name:KIMURA
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:1631 WETZEL AVENUE, BLDG 815
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY, ATTN: FRAN GERNERT CREDENTIALS
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913
Mailing Address - Country:US
Mailing Address - Phone:719-526-5537
Mailing Address - Fax:719-524-2843
Practice Address - Street 1:4TH & INTERLOOP ROAD, BLDG 171
Practice Address - Street 2:US ARMY DENTAL ACTIVITY, ATTN: FRAN GERNERT CREDENTIALS
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92311
Practice Address - Country:US
Practice Address - Phone:719-526-5537
Practice Address - Fax:719-524-2843
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2012-08-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA438031223X0400X
HIDT-24291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics