Provider Demographics
NPI:1497887558
Name:NITTA, LAWRENCE K
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:K
Last Name:NITTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 S BERETANIA ST STE 301
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2551
Mailing Address - Country:US
Mailing Address - Phone:808-536-3963
Mailing Address - Fax:808-533-4906
Practice Address - Street 1:848 S BERETANIA ST STE 301
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2551
Practice Address - Country:US
Practice Address - Phone:808-536-3963
Practice Address - Fax:808-533-4906
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7811223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics