Provider Demographics
NPI:1689824211
Name:OKUDA, GLENN F (DMD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:F
Last Name:OKUDA
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 1:1934 E VINEYARD ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1715
Mailing Address - Country:US
Mailing Address - Phone:808-244-0474
Mailing Address - Fax:
Practice Address - Street 1:1934 E VINEYARD ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1715
Practice Address - Country:US
Practice Address - Phone:808-244-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI13201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice