Healthcare Provider Details

I. General information

NPI: 1104059419
Provider Name (Legal Business Name): LANCE D OGATA D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 HANA HWY SUITE A-2
KAHULUI HI
96732-2315
US

IV. Provider business mailing address

444 HANA HWY SUITE A-2
KAHULUI HI
96732-2315
US

V. Phone/Fax

Practice location:
  • Phone: 808-877-8090
  • Fax: 808-877-8010
Mailing address:
  • Phone: 808-877-8090
  • Fax: 808-877-8010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT-1655
License Number StateHI

VIII. Authorized Official

Name: LANCE D OGATA
Title or Position: PRES
Credential: DDS
Phone: 808-877-8090