Healthcare Provider Details

I. General information

NPI: 1780740068
Provider Name (Legal Business Name): MYLES C. MIYASATO D.D.S.,M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1247 KAAHUMANU ST 316
AIEA HI
96701-5311
US

IV. Provider business mailing address

98-1247 KAAHUMANU ST 316
AIEA HI
96701-5311
US

V. Phone/Fax

Practice location:
  • Phone: 808-488-5880
  • Fax: 808-488-5882
Mailing address:
  • Phone: 808-488-5880
  • Fax: 808-488-5882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number941
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: