Healthcare Provider Details

I. General information

NPI: 1093723157
Provider Name (Legal Business Name): HALEIWA FAMILY DENTAL CENTER, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66-125 KAMEHAMEHA HWY SUITE 2
HALEIWA HI
96712-1420
US

IV. Provider business mailing address

66-125 KAMEHAMEHA HWY SUITE 2
HALEIWA HI
96712-1420
US

V. Phone/Fax

Practice location:
  • Phone: 808-637-9652
  • Fax: 808-637-5688
Mailing address:
  • Phone: 808-637-9652
  • Fax: 808-637-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number1641
License Number StateHI

VIII. Authorized Official

Name: DR. TODD OKAZAKI
Title or Position: DOCTOR
Credential: D.D.S
Phone: 808-637-9652