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General NPI Number Information
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NPI Number | 1659503076
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Entity Type | Organization
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Legal Business Name | WILFRED A. MIYASAKI, D.M.D., INC.
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 1139 BETHEL ST
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City | HONOLULU
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State | HI
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Zip | 96813-2207
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Country | US
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Telephone | 808-533-0000
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Fax | 808-523-1240
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Provider Business Mailing Address
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Address Line | 1139 BETHEL ST
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City | HONOLULU
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State | HI
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Zip | 96813-2207
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Country | US
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Telephone | 808-533-0000
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Fax | 808-523-1240
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILFRED A. MIYASAKI
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Credential | D.M.D.
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Telephone | 808-533-0000
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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 | 940
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License Number State | HI
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