Healthcare Provider Details

I. General information

NPI: 1295139988
Provider Name (Legal Business Name): RYAN TAKESHI INOUYE D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 10/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41-1347 KALANIANAOLE HWY
WAIMANALO HI
96795-1247
US

IV. Provider business mailing address

41-1347 KALANIANAOLE HWY
WAIMANALO HI
96795-1247
US

V. Phone/Fax

Practice location:
  • Phone: 808-259-5466
  • Fax: 808-954-7144
Mailing address:
  • Phone: 808-259-5466
  • Fax: 808-954-7144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT2562
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: