Provider Demographics
NPI:1033231352
Name:IMANAKA, RUSSELL R (DDS)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:R
Last Name:IMANAKA
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 1:1580 MAKALOA ST STE 828
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3220
Mailing Address - Country:US
Mailing Address - Phone:808-941-4497
Mailing Address - Fax:
Practice Address - Street 1:1580 MAKALOA ST STE 828
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3220
Practice Address - Country:US
Practice Address - Phone:808-941-4497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1580122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist