Provider Demographics
NPI:1134484009
Name:SHITAMOTO, LISA YUKIKO (DDS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:YUKIKO
Last Name:SHITAMOTO
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 1:141 MAA ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-3603
Mailing Address - Country:US
Mailing Address - Phone:808-242-6605
Mailing Address - Fax:808-242-5819
Practice Address - Street 1:141 MAA ST UNIT A
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-3603
Practice Address - Country:US
Practice Address - Phone:808-242-6605
Practice Address - Fax:808-242-5819
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI24771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice