Healthcare Provider Details

I. General information

NPI: 1356685341
Provider Name (Legal Business Name): DENNIS T. NAGATA DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 LILIHA ST. SUITE 703
HONOLULU HI
96817
US

IV. Provider business mailing address

1520 LILIHA ST. SUITE 703
HONOLULU HI
96817
US

V. Phone/Fax

Practice location:
  • Phone: 808-526-0670
  • Fax: 808-536-3116
Mailing address:
  • Phone: 808-526-0670
  • Fax: 808-536-3116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1105
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS TSUGIO NAGATA
Title or Position: OWNER
Credential: DDS
Phone: 808-526-0670