Healthcare Provider Details

I. General information

NPI: 1780719500
Provider Name (Legal Business Name): RUTH M OHATA D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 PONAHAWAI ST SUITE 204
HILO HI
96720-3074
US

IV. Provider business mailing address

275 PONAHAWAI ST SUITE 204
HILO HI
96720-3074
US

V. Phone/Fax

Practice location:
  • Phone: 808-961-6704
  • Fax: 808-935-1780
Mailing address:
  • Phone: 808-961-6704
  • Fax: 808-935-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1763
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: