MEDICARE: JULIE T TANABE DDS INC

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1518284249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIE T TANABE DDS INC

Provider Business Mailing Address
First Line	:	3538 WAIALAE AVE STE 206
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-2742
Country	:	US
Telephone Number	:	808-734-8969
Fax Number	:

Provider Business Practice Location Address
First Line	:	3538 WAIALAE AVE STE 206
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-2742
Country	:	US
Telephone Number	:	808-734-8969
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JULIE T. TANABE
Credential	:	D.D.S.
Telephone Number	:	808-734-8969

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	04/20/2010

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