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NPI 1295865756

NPI 1295865756 : BYRON TSUKANO D.D.S. : WAILUKU, HI

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General NPI Number Information
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    NPI Number           |    1295865756
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    Entity Type          |    Individual 
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    Provider Name        |    BYRON TSUKANO D.D.S.
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    03/06/2007
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    Last Update Date     |    07/08/2007
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Provider Practice Location Address
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    Address Line         |    1371 LOWER MAIN ST UNIT 5
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    City                 |    WAILUKU
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    State                |    HI
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    Zip                  |    96793-1945
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    Country              |    US
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    Telephone            |    808-243-2277
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    Fax                  |    808-242-4466
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Provider Business Mailing Address
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    Address Line         |    1371 LOWER MAIN STREET UNIT 5
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    City                 |    WAILUKU
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    State                |    HI
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    Zip                  |    96793-1961
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    Country              |    US
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    Telephone            |    808-243-2277
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    Fax                  |    808-242-4466
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    1223G0001X
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    Taxonomy Name        |    General Practice Dentistry
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    License Number       |    DT1789
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    License Number State |    HI
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