Provider Demographics
NPI:1851481964
Name:SHIROTA, BRADY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRADY
Middle Name:J
Last Name:SHIROTA
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 1:1839 WELLS ST
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2361
Mailing Address - Country:US
Mailing Address - Phone:808-244-7454
Mailing Address - Fax:808-244-7454
Practice Address - Street 1:1839 WELLS ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2361
Practice Address - Country:US
Practice Address - Phone:808-244-7454
Practice Address - Fax:808-244-7454
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 18661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice