MEDICARE: WINDWARD CITY FAMILY DENTISTRY

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	185101	HI

General Provider Information

NPI Number	:	1881826543
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDWARD CITY FAMILY DENTISTRY

Provider Business Mailing Address
First Line	:	45-480 KANEOHE BAY DR
Second Line	:
City	:	KANEOHE
State	:	HI
Zip	:	96744-2039
Country	:	US
Telephone Number	:	808-235-4524
Fax Number	:	808-235-4526

Provider Business Practice Location Address
First Line	:	45-480 KANEOHE BAY DR
Second Line	:
City	:	KANEOHE
State	:	HI
Zip	:	96744-2039
Country	:	US
Telephone Number	:	808-235-4524
Fax Number	:	808-235-4526

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY K MIYAZAWA
Credential	:	D.D.S.
Telephone Number	:	808-235-4524

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	08/13/2009

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