Provider Demographics
NPI:1891077467
Name:EBIHARA, KUMI (DMD)
Entity Type:Individual
Prefix:DR
First Name:KUMI
Middle Name:
Last Name:EBIHARA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 FALKLAND RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-3512
Mailing Address - Country:US
Mailing Address - Phone:917-684-9411
Mailing Address - Fax:
Practice Address - Street 1:128 N BLAKELEY ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-1823
Practice Address - Country:US
Practice Address - Phone:360-794-8292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADENT.DE.61218276122300000X
RIDEN03134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist