Provider Demographics
NPI:1003822321
Name:OGATA, LANCE DIAMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:DIAMOND
Last Name:OGATA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 HANA HWY STE A2
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2315
Mailing Address - Country:US
Mailing Address - Phone:808-877-8090
Mailing Address - Fax:808-877-8010
Practice Address - Street 1:444 HANA HWY STE A2
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2315
Practice Address - Country:US
Practice Address - Phone:808-877-8090
Practice Address - Fax:808-877-8010
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI16551223G0001X
CA368131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice