Individual
DR. KYLE T FUKANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1684 MAIN ST, SUITE 4, FREELAND, WA 98249
(360) 331-5211
(360) 331-5212
Mailing address
PO BOX 729, FREELAND, WA 98249-0729
(360) 331-5211
(360) 331-5212
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DE00008801
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE00008801
DDS LICENSE
WA
Enumeration date
09/13/2006
Last updated
12/23/2015
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