Provider Demographics
NPI:1104830454
Name:WADA, CANDACE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:M
Last Name:WADA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 WAIALAE AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5306
Mailing Address - Country:US
Mailing Address - Phone:808-732-9232
Mailing Address - Fax:808-739-2132
Practice Address - Street 1:4211 WAIALAE AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5306
Practice Address - Country:US
Practice Address - Phone:808-732-9232
Practice Address - Fax:808-739-2132
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI19221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1922OtherSTATE LICENSE NUMBER