Healthcare Provider Details

I. General information

NPI: 1396909081
Provider Name (Legal Business Name): LAWRENCE M YAMADA DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD SUITE 1008
HONOLULU HI
96814-4402
US

IV. Provider business mailing address

1498 ALA MAHAMOE ST
HONOLULU HI
96819-1763
US

V. Phone/Fax

Practice location:
  • Phone: 808-593-9980
  • Fax:
Mailing address:
  • Phone: 808-593-9980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number455
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: