Provider Demographics
NPI:1275623332
Name:HAGA, CRAIG SHOICHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:SHOICHI
Last Name:HAGA
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 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-591-1515
Mailing Address - Fax:808-593-8628
Practice Address - Street 1:1441 KAPIOLANI BLVD.
Practice Address - Street 2:SUITE 208
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-591-1515
Practice Address - Fax:808-593-8628
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT1690122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51959801Medicaid