Provider Demographics
NPI:1356480412
Name:SAKURAI, MARK DWIGHT (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DWIGHT
Last Name:SAKURAI
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 1:94 239 WAIPAHU DEPOT 87
Mailing Address - Street 2:SUITE #212
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2036
Mailing Address - Country:US
Mailing Address - Phone:808-671-4958
Mailing Address - Fax:808-678-0191
Practice Address - Street 1:94 239 WAIPAHU DEPOT 87
Practice Address - Street 2:SUITE #212
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2036
Practice Address - Country:US
Practice Address - Phone:808-671-4958
Practice Address - Fax:808-678-0191
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 1359122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI526212 02Medicaid