Provider Demographics
NPI:1346795408
Name:TAKAGI, BRENNAN NICHOLAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRENNAN
Middle Name:NICHOLAS
Last Name:TAKAGI
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 1:1600 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 807
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3801
Mailing Address - Country:US
Mailing Address - Phone:808-949-0033
Mailing Address - Fax:808-943-4316
Practice Address - Street 1:1600 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 807
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3801
Practice Address - Country:US
Practice Address - Phone:808-949-0033
Practice Address - Fax:808-943-4316
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-26621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice