Provider Demographics
NPI:1891905501
Name:MIYASHIRO, BRUCE T (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:T
Last Name:MIYASHIRO
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 1:91 LANIHULI ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4142
Mailing Address - Country:US
Mailing Address - Phone:808-961-0631
Mailing Address - Fax:808-969-1558
Practice Address - Street 1:91 LANIHULI ST STE 1
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4142
Practice Address - Country:US
Practice Address - Phone:808-961-0631
Practice Address - Fax:808-969-1558
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice