Provider Demographics
NPI:1932327376
Name:FUJITA, TAKANOBU (DDS)
Entity Type:Individual
Prefix:
First Name:TAKANOBU
Middle Name:
Last Name:FUJITA
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 1:1 HERMANN MUSEUM CIRCLE DR
Mailing Address - Street 2:APT 4073
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-7390
Mailing Address - Country:US
Mailing Address - Phone:303-562-6001
Mailing Address - Fax:
Practice Address - Street 1:3219 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-8805
Practice Address - Country:US
Practice Address - Phone:972-252-7569
Practice Address - Fax:972-258-0502
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX243341223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry