Provider Demographics
NPI:1790791119
Name:WAI, ROBERT M JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:WAI
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 S KING ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-2117
Mailing Address - Country:US
Mailing Address - Phone:808-593-8488
Mailing Address - Fax:808-593-9882
Practice Address - Street 1:1040 S KING ST
Practice Address - Street 2:SUITE 301
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2117
Practice Address - Country:US
Practice Address - Phone:808-593-8488
Practice Address - Fax:808-593-9882
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI889OtherHAWAII DENTAL SERVICE NUM
HI8714-8OtherHMSA ID NUMBER