Provider Demographics
NPI:1437910577
Name:GARY T ODA DDS
Entity Type:Organization
Organization Name:GARY T ODA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:ODA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-689-7966
Mailing Address - Street 1:91-791 PAPIPI RD RM 1
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2456
Mailing Address - Country:US
Mailing Address - Phone:808-689-7966
Mailing Address - Fax:808-689-0966
Practice Address - Street 1:91-791 PAPIPI RD RM 1
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2456
Practice Address - Country:US
Practice Address - Phone:808-689-7966
Practice Address - Fax:808-689-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty