Healthcare Provider Details

I. General information

NPI: 1013531656
Provider Name (Legal Business Name): MICHAEL TADAYUKI MIYAMOTO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PIIKOI ST STE 1101
HONOLULU HI
96814-3141
US

IV. Provider business mailing address

615 PIIKOI ST STE 1101
HONOLULU HI
96814-3141
US

V. Phone/Fax

Practice location:
  • Phone: 808-596-2622
  • Fax:
Mailing address:
  • Phone: 808-596-2622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT-3153
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDT-3153
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: