Provider Demographics
NPI:1275681603
Name:TAKATA, CECIL JIRO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CECIL
Middle Name:JIRO
Last Name:TAKATA
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 1:94-235 HANAWAI CIR STE 1
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3029
Mailing Address - Country:US
Mailing Address - Phone:808-677-5944
Mailing Address - Fax:808-677-3711
Practice Address - Street 1:94-235 HANAWAI CIR STE 1
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3029
Practice Address - Country:US
Practice Address - Phone:808-677-5944
Practice Address - Fax:808-677-3711
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 1001122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist