Provider Demographics
NPI:1407998099
Name:NAKAMURA, RONALD MIZUO (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MIZUO
Last Name:NAKAMURA
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 1:1811 S KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2137
Mailing Address - Country:US
Mailing Address - Phone:808-949-7851
Mailing Address - Fax:
Practice Address - Street 1:1811 S KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2137
Practice Address - Country:US
Practice Address - Phone:808-949-7851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI0007321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice