Individual
MATTHEW KIKUCHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1459 LANEY WALKER BLVD, AUGUSTA, GA 30912-0002
(706) 721-9744
Mailing address
1459 LANEY WALKER BLVD, AUGUSTA, GA 30912-0002
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7719205-9921
UT
Other
Enumeration date
07/15/2010
Last updated
05/08/2012
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