Provider Demographics
NPI:1528187903
Name:TASAKI, MARK MAKOTO (DDS MS PHD INC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:MAKOTO
Last Name:TASAKI
Suffix:
Gender:M
Credentials:DDS MS PHD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 KAPIOLANI BLVD
Mailing Address - Street 2:STE C-102
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-596-0000
Mailing Address - Fax:808-596-0771
Practice Address - Street 1:725 KAPIOLANI BLVD
Practice Address - Street 2:STE C-102
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-596-0000
Practice Address - Fax:808-596-0771
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-16701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice