Provider Demographics
NPI:1851624498
Name:BRUCE T. MIYASHIRO, D.D.S., INC.
Entity Type:Organization
Organization Name:BRUCE T. MIYASHIRO, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MIYASHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-961-0631
Mailing Address - Street 1:91 LANIHULL ST.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-7202
Mailing Address - Country:US
Mailing Address - Phone:808-961-0631
Mailing Address - Fax:808-969-1558
Practice Address - Street 1:91 LANIHULL ST.
Practice Address - Street 2:SUITE 1
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7202
Practice Address - Country:US
Practice Address - Phone:808-961-0631
Practice Address - Fax:808-969-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty