Provider Demographics
NPI:1760546709
Name:SUGIUCHI, MAKOTO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAKOTO
Middle Name:
Last Name:SUGIUCHI
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 1:33720 9TH AVE S
Mailing Address - Street 2:SUITE #1
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6735
Mailing Address - Country:US
Mailing Address - Phone:253-874-2156
Mailing Address - Fax:253-874-2175
Practice Address - Street 1:33720 9TH AVE S
Practice Address - Street 2:SUITE #1
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6735
Practice Address - Country:US
Practice Address - Phone:253-874-2156
Practice Address - Fax:253-874-2175
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00009850122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist