Provider Demographics
NPI:1740417559
Name:JASON M TANAKA DDS INC
Entity Type:Organization
Organization Name:JASON M TANAKA DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:GUINTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-521-6707
Mailing Address - Street 1:1520 LILIHA ST STE 502
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3564
Mailing Address - Country:US
Mailing Address - Phone:808-521-6707
Mailing Address - Fax:808-528-5967
Practice Address - Street 1:1520 LILIHA ST STE 502
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3564
Practice Address - Country:US
Practice Address - Phone:808-521-6707
Practice Address - Fax:808-528-5967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1392-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty