Yasuyuki Fukuto, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11825 Issued in OR

Practice address

521 N 1St Ave
Stayton, OR 97383-1703

Phone

(503) 769-9699

NPI assigned

Jul 24, 2023

Last updated

Jul 24, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advantage Dental Group, PC

  dba Advantage Dental Oral Health Center

  • General Practice Dentistry
  • Bandon, OR
  • NPI 1447812813
  NPD (past)
• Advantage Dental Group, PC

  dba Advantage Dental Oral Health Center

  • General Practice Dentistry
  • Boardman, OR
  • NPI 1831741958
  NPD (past)
• Mill Creek Dental, Inc.

  • General Practice Dentistry
  • Stayton, OR
  • NPI 1497823546
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1922788975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11470",
            "city": "EUGENE",
            "state": "OR",
            "postal_code": "974403670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 N 1ST AVE",
            "city": "STAYTON",
            "state": "OR",
            "postal_code": "973831703",
            "telephone_number": "503-769-9699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUKUTO",
        "first_name": "YASUYUKI",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-07-24",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11825",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Debby Jean Flores, PEER SPECIALIST
• David Foster, MD
• Marie Mona Francois, MSN
• James A Frank, MD
• Christopher Fu, RD, LDN
• Scott Demar Gale
• Gathered & Wise LLC
• Mary Margaret Gescher
• Amanda Gildersleeve, NP-C
• Fred Frank Girod, DMD

• General Practice Dentistry in Stayton, OR
• Providers in Stayton, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.