Healthcare Provider Details

I. General information

NPI: 1285603373
Provider Name (Legal Business Name): PEDODONTIC ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1005 MOANALUA RD. STE. 847
AIEA HI
96701-4726
US

IV. Provider business mailing address

98-1005 MOANALUA ROAD STE. 847
AIEA HI
96701-4726
US

V. Phone/Fax

Practice location:
  • Phone: 808-487-7933
  • Fax: 808-484-2351
Mailing address:
  • Phone: 808-487-7933
  • Fax: 808-484-2351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ALAN TAKESHI SATO
Title or Position: D.D.S. / HIPPA PRIVACY-SECURITY OF.
Credential: D.D.S.
Phone: 808-487-7933