Provider Demographics
NPI:1790990869
Name:MATSUMOTO, RANDAL S (DDS)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:S
Last Name:MATSUMOTO
Suffix:
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 1:742 OLOKELE AVE
Mailing Address - Street 2:APT #301
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-1084
Mailing Address - Country:US
Mailing Address - Phone:808-739-0381
Mailing Address - Fax:
Practice Address - Street 1:1451 S KING ST
Practice Address - Street 2:SUITE #407
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-2506
Practice Address - Country:US
Practice Address - Phone:808-955-7100
Practice Address - Fax:808-955-6958
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice