Healthcare Provider Details

I. General information

NPI: 1316045370
Provider Name (Legal Business Name): GLENN MICHIO OKIHIRO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 KAMEHAMEHA HWY ROOM 110
PEARL CITY HI
96782-2656
US

IV. Provider business mailing address

850 KAMEHAMEHA HWY ROOM 110
PEARL CITY HI
96782-2656
US

V. Phone/Fax

Practice location:
  • Phone: 808-455-4173
  • Fax: 808-455-3280
Mailing address:
  • Phone: 808-455-4173
  • Fax: 808-455-3280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1162-
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: