Healthcare Provider Details

I. General information

NPI: 1649722547
Provider Name (Legal Business Name): DENTAL TECHNOLOGY CENTER OF HAWAII LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 S KING ST STE 724
HONOLULU HI
96814-1942
US

IV. Provider business mailing address

1314 S KING ST STE 724
HONOLULU HI
96814-1942
US

V. Phone/Fax

Practice location:
  • Phone: 808-291-2254
  • Fax:
Mailing address:
  • Phone: 808-291-2254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: DR. WADE TAKENISHI
Title or Position: DENTIST
Credential: DDS
Phone: 808-291-2254