Healthcare Provider Details

I. General information

NPI: 1760624761
Provider Name (Legal Business Name): PERIODONTAL & IMPLANT ASSOCIATES OF HAWAII
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 04/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 S BERETANIA ST
HONOLULU HI
96826-1307
US

IV. Provider business mailing address

1833 S BERETANIA ST
HONOLULU HI
96826-1307
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-2275
  • Fax: 808-942-4608
Mailing address:
  • Phone: 808-955-2275
  • Fax: 808-942-4608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number0813
License Number StateHI

VIII. Authorized Official

Name: DR. CLYDE S UMAKI
Title or Position: PRESIDENT/OWNER
Credential: DDS, MS
Phone: 808-955-2275