Provider Demographics
NPI:1265648836
Name:MAEDA, CALVIN K (DDS)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:K
Last Name:MAEDA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 AULIKE ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2707
Mailing Address - Country:US
Mailing Address - Phone:808-262-6511
Mailing Address - Fax:808-261-0754
Practice Address - Street 1:30 AULIKE ST
Practice Address - Street 2:SUITE 401
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2707
Practice Address - Country:US
Practice Address - Phone:808-262-6511
Practice Address - Fax:808-261-0754
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI658255OtherUNITED CONCORDIA
HI06318301OtherMEDICAID