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NPI Code Detail

MEDICARE: JULIE T. TANABE GOO D.D.S.

MEDICARE:   JULIE T. TANABE GOO  D.D.S.
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
11223G0001XGeneral Practice DentistryDT-1891HI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11891OTHERHIHDS PROVIDER NO.
2DT 1891OTHERHISTATE DENTIST LICENSE NO.
3208538OTHERHIHMSA PROVIDER NO.

General Provider Information

NPI Number : 1912082348
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE T. TANABE GOO D.D.S.
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 : 808-737-2634
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 : 808-737-2634
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 07/08/2007

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Directions to “ JULIE T. TANABE GOO D.D.S.” Practice Location

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