Healthcare Provider Details

I. General information

NPI: 1326169855
Provider Name (Legal Business Name): RICHARD H MIYAMOTO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 08/18/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 PIIKOI ST SUITE 1101
HONOLULU HI
96814-3116
US

IV. Provider business mailing address

615 PIIKOI ST SUITE 1101
HONOLULU HI
96814-3116
US

V. Phone/Fax

Practice location:
  • Phone: 808-596-2622
  • Fax: 808-596-2625
Mailing address:
  • Phone: 808-596-2622
  • Fax: 808-596-2625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDT1449
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: