=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750726410
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMY A OGAWA DMD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2013
-----------------------------------------------------
Last Update Date | 05/07/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 94-801 FARRINGTON HWY STE 202
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-3149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-678-8999
-----------------------------------------------------
Fax | 808-671-8883
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 94-801 FARRINGTON HWY STE 202
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-3149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-678-8999
-----------------------------------------------------
Fax | 808-671-8883
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | AMY A OGAWA
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 808-678-8999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 1452
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------