Healthcare Provider Details

I. General information

NPI: 1336113125
Provider Name (Legal Business Name): JAMES M SAGAWA DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 LANAI AVENUE SUITE #101
LANAI CITY HI
96763-0117
US

IV. Provider business mailing address

PO BOX 630117
LANAI CITY HI
96763-0117
US

V. Phone/Fax

Practice location:
  • Phone: 808-565-6418
  • Fax: 808-565-6418
Mailing address:
  • Phone: 808-565-6418
  • Fax: 808-565-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number740
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD4167
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: