Healthcare Provider Details

I. General information

NPI: 1770567570
Provider Name (Legal Business Name): KIMBERLY ANN SAYA INOUYE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 HOFF STREET USA DENTAC
FT BENNING GA
31905
US

IV. Provider business mailing address

7101 HOFF STREET USA DENTAC
FT BENNING GA
31905
US

V. Phone/Fax

Practice location:
  • Phone: 706-544-4530
  • Fax: 706-544-1933
Mailing address:
  • Phone: 706-544-4530
  • Fax: 706-544-1933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2166
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDT-2166
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: