Provider Demographics
NPI:1396367207
Name:MIYAMOTO, AARON MASARU (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:MASARU
Last Name:MIYAMOTO
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 1:4565 ALIIKOA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-1158
Mailing Address - Country:US
Mailing Address - Phone:808-228-4001
Mailing Address - Fax:
Practice Address - Street 1:4565 ALIIKOA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1158
Practice Address - Country:US
Practice Address - Phone:808-228-4001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-13
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
HI29211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program