Healthcare Provider Details

I. General information

NPI: 1417067315
Provider Name (Legal Business Name): CLYDE G.C. MEW D.D.S., M.SC.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 S KING ST SUITE 209
HONOLULU HI
96826-2225
US

IV. Provider business mailing address

2065 S KING ST SUITE 209
HONOLULU HI
96826-2225
US

V. Phone/Fax

Practice location:
  • Phone: 808-947-4222
  • Fax:
Mailing address:
  • Phone: 808-947-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number942
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: