MEDICARE: DR. GLENN MICHIO OKIHIRO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	1162-	HI

General Provider Information

NPI Number	:	1316045370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN MICHIO OKIHIRO D.D.S.

Provider Business Mailing Address
First Line	:	850 KAMEHAMEHA HWY
Second Line	:	ROOM 110
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2656
Country	:	US
Telephone Number	:	808-455-4173
Fax Number	:	808-455-3280

Provider Business Practice Location Address
First Line	:	850 KAMEHAMEHA HWY
Second Line	:	ROOM 110
City	:	PEARL CITY
State	:	HI
Zip	:	96782-2656
Country	:	US
Telephone Number	:	808-455-4173
Fax Number	:	808-455-3280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/08/2007

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