Provider Demographics
NPI:1912320482
Name:FUJIMURA, ATSUSHI (DDS)
Entity type:Individual
Prefix:
First Name:ATSUSHI
Middle Name:
Last Name:FUJIMURA
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 1:100 GRAND AVE APT 2303
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3090
Mailing Address - Country:US
Mailing Address - Phone:858-242-2252
Mailing Address - Fax:
Practice Address - Street 1:6431 FAIRMOUNT AVE STE 2
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-3624
Practice Address - Country:US
Practice Address - Phone:510-524-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1027731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty