Provider Demographics
NPI:1093166407
Name:GLENN Y. TAKAKI DDS LLC
Entity Type:Organization
Organization Name:GLENN Y. TAKAKI DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKAKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-352-3134
Mailing Address - Street 1:98-211 PALI MOMI ST
Mailing Address - Street 2:SUITE 737
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4301
Mailing Address - Country:US
Mailing Address - Phone:808-487-1554
Mailing Address - Fax:877-420-4686
Practice Address - Street 1:98-211 PALI MOMI ST
Practice Address - Street 2:SUITE 737
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4301
Practice Address - Country:US
Practice Address - Phone:808-487-1554
Practice Address - Fax:877-420-4686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2107122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty