Provider Demographics
NPI:1356450084
Name:MISAKI, HARVEY TSUTOMA (DDS)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:TSUTOMA
Last Name:MISAKI
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 1:133 WESTERVELT STREET
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1929
Mailing Address - Country:US
Mailing Address - Phone:808-621-8677
Mailing Address - Fax:808-621-7537
Practice Address - Street 1:133 WESTERVELT STREET
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1929
Practice Address - Country:US
Practice Address - Phone:808-621-8677
Practice Address - Fax:808-621-7537
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
791890OtherUNITED CONCORDIA
HIB23420Medicaid
HIB23420OtherHI MEDICAL SERVICE ASSOC.