Provider Demographics
NPI:1760611685
Name:FURUMOTO, BRENT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:M
Last Name:FURUMOTO
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 1:21660 COPLEY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4176
Mailing Address - Country:US
Mailing Address - Phone:909-861-3515
Mailing Address - Fax:909-861-2795
Practice Address - Street 1:21660 COPLEY DR STE 200
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4176
Practice Address - Country:US
Practice Address - Phone:909-861-3515
Practice Address - Fax:909-861-2795
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55164122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist