Provider Demographics
NPI:1457453821
Name:TAMARU, RICHARD HISAO (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:HISAO
Last Name:TAMARU
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 1:615 PIIKOI ST
Mailing Address - Street 2:SUITE 804
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3140
Mailing Address - Country:US
Mailing Address - Phone:808-589-2711
Mailing Address - Fax:808-595-8704
Practice Address - Street 1:615 PIIKOI ST
Practice Address - Street 2:SUITE 804
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3140
Practice Address - Country:US
Practice Address - Phone:808-589-2711
Practice Address - Fax:808-595-8704
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-15051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIB2402-2OtherHMSA
HI8-1505OtherHAWAII DENTAL SERVICE