Healthcare Provider Details

I. General information

NPI: 1013240704
Provider Name (Legal Business Name): DEAN T. SUEDA DDS.MS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD SUITE 617
HONOLULU HI
96814-4402
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD SUITE 617
HONOLULU HI
96814-4402
US

V. Phone/Fax

Practice location:
  • Phone: 808-944-1603
  • Fax: 808-949-3100
Mailing address:
  • Phone: 808-944-1603
  • Fax: 808-949-3100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number1066
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number1066
License Number StateHI

VIII. Authorized Official

Name: DEAN T SUEDA
Title or Position: PRESIDENT
Credential: DDS
Phone: 808-944-1603