Provider Demographics
NPI:1245368596
Name:FURUTA, NICOLE KIKUE (DDS)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:KIKUE
Last Name:FURUTA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 WAZEE ST STE 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-1491
Mailing Address - Country:US
Mailing Address - Phone:303-623-5636
Mailing Address - Fax:303-623-5640
Practice Address - Street 1:1435 WAZEE ST STE 102
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-1491
Practice Address - Country:US
Practice Address - Phone:303-623-5636
Practice Address - Fax:303-623-5640
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist