Individual
YASUYUKI FUKUTO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
521 N 1ST AVE, STAYTON, OR 97383-1703
(503) 769-9699
Mailing address
PO BOX 11470, EUGENE, OR 97440-3670
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D11825
OR
1223G0001X
General Practice Dentistry
Primary
D11825
OR
Other
Enumeration date
07/24/2023
Last updated
07/24/2023
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