Provider Demographics
NPI:1003856162
Name:MORITMOTO, RICHARD S (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:S
Last Name:MORITMOTO
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 1:43 ONEAWA ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2526
Mailing Address - Country:US
Mailing Address - Phone:808-262-6344
Mailing Address - Fax:808-262-2743
Practice Address - Street 1:43 ONEAWA ST
Practice Address - Street 2:SUITE 209
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2526
Practice Address - Country:US
Practice Address - Phone:808-262-6344
Practice Address - Fax:808-262-2743
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI06340301Medicaid