Healthcare Provider Details

I. General information

NPI: 1457430985
Provider Name (Legal Business Name): MODESTA GAERLAN-TOKUNAGA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-307 FARRINGTON HWY STE A10
WAIPAHU HI
96797-2500
US

IV. Provider business mailing address

94-307 FARRINGTON HWY STE A10
WAIPAHU HI
96797-2500
US

V. Phone/Fax

Practice location:
  • Phone: 808-671-9166
  • Fax: 808-671-6236
Mailing address:
  • Phone: 808-671-9166
  • Fax: 808-671-6236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT 1529
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: