Provider Demographics
NPI:1760624761
Name:PERIODONTAL & IMPLANT ASSOCIATES OF HAWAII
Entity Type:Organization
Organization Name:PERIODONTAL & IMPLANT ASSOCIATES OF HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:S
Authorized Official - Last Name:UMAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:808-955-2275
Mailing Address - Street 1:1833 S BERETANIA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-1307
Mailing Address - Country:US
Mailing Address - Phone:808-955-2275
Mailing Address - Fax:808-942-4608
Practice Address - Street 1:1833 S BERETANIA ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1307
Practice Address - Country:US
Practice Address - Phone:808-955-2275
Practice Address - Fax:808-942-4608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI08131223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty