Provider Demographics
NPI:1316045370
Name:OKIHIRO, GLENN MICHIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:MICHIO
Last Name:OKIHIRO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 KAMEHAMEHA HWY
Mailing Address - Street 2:ROOM 110
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2656
Mailing Address - Country:US
Mailing Address - Phone:808-455-4173
Mailing Address - Fax:808-455-3280
Practice Address - Street 1:850 KAMEHAMEHA HWY
Practice Address - Street 2:ROOM 110
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2656
Practice Address - Country:US
Practice Address - Phone:808-455-4173
Practice Address - Fax:808-455-3280
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1162-1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice