Provider Demographics
NPI:1710227376
Name:RUSSELL K TASAKA, DMD
Entity Type:Organization
Organization Name:RUSSELL K TASAKA, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:K
Authorized Official - Last Name:TASAKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-737-9032
Mailing Address - Street 1:2024 N KING ST
Mailing Address - Street 2:107
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3456
Mailing Address - Country:US
Mailing Address - Phone:808-841-7944
Mailing Address - Fax:
Practice Address - Street 1:3221 WAIALAE AVE
Practice Address - Street 2:STE 376
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5842
Practice Address - Country:US
Practice Address - Phone:808-737-9032
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RUSSELL K TASAKA, DMD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-19
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1612122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1841308723Medicaid