Provider Demographics
NPI:1528104254
Name:FUTENMA, CARL CHOSEI (DDS)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:CHOSEI
Last Name:FUTENMA
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 1:27504 NE 14TH CT
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:WA
Mailing Address - Zip Code:98642-8472
Mailing Address - Country:US
Mailing Address - Phone:360-887-4429
Mailing Address - Fax:
Practice Address - Street 1:3405 NE 78TH ST
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-0657
Practice Address - Country:US
Practice Address - Phone:360-574-3061
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA83281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice