Provider Demographics
NPI:1538295027
Name:MARK TASAKI DDS MS PHD INC
Entity Type:Organization
Organization Name:MARK TASAKI DDS MS PHD INC
Other - Org Name:TASAKI TMJ HEADACHE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:MAKOTO
Authorized Official - Last Name:TASAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS PHD INC
Authorized Official - Phone:808-596-0000
Mailing Address - Street 1:725 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 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:SUITE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT16701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty