Provider Demographics
NPI:1336113125
Name:SAGAWA, JAMES M (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:SAGAWA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 630117
Mailing Address - Street 2:
Mailing Address - City:LANAI CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96763-0117
Mailing Address - Country:US
Mailing Address - Phone:808-565-6418
Mailing Address - Fax:808-565-6742
Practice Address - Street 1:730 LANAI AVENUE
Practice Address - Street 2:SUITE #101
Practice Address - City:LANAI CITY
Practice Address - State:HI
Practice Address - Zip Code:96763-0117
Practice Address - Country:US
Practice Address - Phone:808-565-6418
Practice Address - Fax:808-565-6418
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7401223G0001X
ORD41671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIB210977OtherHMSA
HI24642101Medicaid
HI9740OtherHDS
HI47198OtherBCBS