Provider Demographics
NPI:1326169855
Name:MIYAMOTO, RICHARD H (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:MIYAMOTO
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 1:615 PIIKOI ST
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3116
Mailing Address - Country:US
Mailing Address - Phone:808-596-2622
Mailing Address - Fax:808-596-2625
Practice Address - Street 1:615 PIIKOI ST
Practice Address - Street 2:SUITE 1101
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3116
Practice Address - Country:US
Practice Address - Phone:808-596-2622
Practice Address - Fax:808-596-2625
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT14491223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI671673OtherUNITED CONCORDIA
HIB001990-7OtherBLUE CROSS BLUE SHIELD