MEDICARE: DR. CLYDE G.C. MEW D.D.S., M.SC.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	942	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8811-2	OTHER	HI	HMSA BLUECROSSBLUESHIELD
2	942	OTHER	HI	HAWAII DENTAL LICENSE #

General Provider Information

NPI Number	:	1417067315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLYDE G.C. MEW D.D.S., M.SC.D.

Provider Business Mailing Address
First Line	:	2065 S KING ST
Second Line	:	SUITE 209
City	:	HONOLULU
State	:	HI
Zip	:	96826-2225
Country	:	US
Telephone Number	:	808-947-4222
Fax Number	:

Provider Business Practice Location Address
First Line	:	2065 S KING ST
Second Line	:	SUITE 209
City	:	HONOLULU
State	:	HI
Zip	:	96826-2225
Country	:	US
Telephone Number	:	808-947-4222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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