Provider Demographics
NPI:1093723157
Name:HALEIWA FAMILY DENTAL CENTER, LTD.
Entity Type:Organization
Organization Name:HALEIWA FAMILY DENTAL CENTER, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:OKAZAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-637-9652
Mailing Address - Street 1:66-125 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-1420
Mailing Address - Country:US
Mailing Address - Phone:808-637-9652
Mailing Address - Fax:808-637-5688
Practice Address - Street 1:66-125 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1420
Practice Address - Country:US
Practice Address - Phone:808-637-9652
Practice Address - Fax:808-637-5688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1641251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare