Provider Demographics
NPI:1447395223
Name:SUGIYAMA, CHARLES RYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RYAN
Last Name:SUGIYAMA
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 1:31 E LANIKAULA ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4362
Mailing Address - Country:US
Mailing Address - Phone:808-934-8800
Mailing Address - Fax:808-935-1766
Practice Address - Street 1:31 E LANIKAULA ST
Practice Address - Street 2:SUITE C
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4362
Practice Address - Country:US
Practice Address - Phone:808-934-8800
Practice Address - Fax:808-935-1766
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice