Provider Demographics
NPI:1881826543
Name:WINDWARD CITY FAMILY DENTISTRY
Entity Type:Organization
Organization Name:WINDWARD CITY FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MIYAZAWA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-235-4524
Mailing Address - Street 1:45-480 KANEOHE BAY DR
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2039
Mailing Address - Country:US
Mailing Address - Phone:808-235-4524
Mailing Address - Fax:808-235-4526
Practice Address - Street 1:45-480 KANEOHE BAY DR
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2039
Practice Address - Country:US
Practice Address - Phone:808-235-4524
Practice Address - Fax:808-235-4526
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
HI1851011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty