Provider Demographics
NPI:1790838068
Name:SASADA, JENNIFER (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:SASADA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ALA MOANA BLVD
Mailing Address - Street 2:SUITE 7-220
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4920
Mailing Address - Country:US
Mailing Address - Phone:808-523-3103
Mailing Address - Fax:808-523-3122
Practice Address - Street 1:98-150 KAONOHI ST
Practice Address - Street 2:SUITE C201
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5047
Practice Address - Country:US
Practice Address - Phone:808-488-3368
Practice Address - Fax:808-486-5729
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist