Healthcare Provider Details

I. General information

NPI: 1376706960
Provider Name (Legal Business Name): MICHAEL M. OKANO, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 KAMOKILA BLVD JAMES CAMPBELL BLDG., SUITE 102
KAPOLEI HI
96707-2014
US

IV. Provider business mailing address

1001 KAMOKILA BLVD JAMES CAMPBELL BLDG., SUITE 102
KAPOLEI HI
96707-2014
US

V. Phone/Fax

Practice location:
  • Phone: 808-674-9299
  • Fax:
Mailing address:
  • Phone: 808-674-9299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDT-1558
License Number StateHI

VIII. Authorized Official

Name: MICHAEL OKANO
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 808-674-9299