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General NPI Number Information
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NPI Number | 1871728881
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Entity Type | Organization
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Legal Business Name | WADE TAKENISHI D.D.S. L.L.C.
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Dates
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Enumeration Date | 05/19/2009
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 1314 S KING ST STE 702
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City | HONOLULU
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State | HI
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Zip | 96814-1942
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Country | US
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Telephone | 808-593-2775
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Fax |
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Provider Business Mailing Address
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Address Line | 1314 S KING ST STE 702
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City | HONOLULU
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State | HI
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Zip | 96814-1942
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. WADE TAKENISHI
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Credential | D.D.S.
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Telephone | 808-593-2775
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1905
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License Number State | HI
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