Provider Demographics
NPI:1033268032
Name:AZAMA, ROBERT K (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:AZAMA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 KAMEHAMEHA HWY
Mailing Address - Street 2:#115
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2603
Mailing Address - Country:US
Mailing Address - Phone:808-455-8577
Mailing Address - Fax:808-455-8577
Practice Address - Street 1:850 KAMEHAMEHA HWY
Practice Address - Street 2:#115
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2603
Practice Address - Country:US
Practice Address - Phone:808-455-8577
Practice Address - Fax:808-455-8577
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04141401Medicaid