Healthcare Provider Details

I. General information

NPI: 1306907985
Provider Name (Legal Business Name): DAVID HARUO OTA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W HIND DR SUITE 115
HONOLULU HI
96821-1855
US

IV. Provider business mailing address

850 W HIND DR SUITE 115
HONOLULU HI
96821-1855
US

V. Phone/Fax

Practice location:
  • Phone: 808-373-9895
  • Fax: 808-373-9651
Mailing address:
  • Phone: 808-373-9895
  • Fax: 808-373-9651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number883
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: