Provider Demographics
NPI:1962853655
Name:KATAFUCHI, MICHITSUNA (DDS, MSD, PHD)
Entity Type:Individual
Prefix:
First Name:MICHITSUNA
Middle Name:
Last Name:KATAFUCHI
Suffix:
Gender:M
Credentials:DDS, MSD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 140TH PL NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4049
Mailing Address - Country:US
Mailing Address - Phone:206-849-2970
Mailing Address - Fax:
Practice Address - Street 1:12911 120TH AVE NE STE F240
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3054
Practice Address - Country:US
Practice Address - Phone:425-820-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 606627891223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics