Provider Demographics
NPI:1790917417
Name:CASEY TAMASHIRO DDS, INC
Entity Type:Organization
Organization Name:CASEY TAMASHIRO DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMASHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-244-6000
Mailing Address - Street 1:1728 WILI PA LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-1284
Mailing Address - Country:US
Mailing Address - Phone:808-244-6000
Mailing Address - Fax:
Practice Address - Street 1:1728 WILI PA LOOP STE 100
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1284
Practice Address - Country:US
Practice Address - Phone:808-244-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT17431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1223G0001XOtherGENERAL DENTISTRY