Provider Demographics
NPI:1902845514
Name:MIYAMURA, MYRTLE H (DMD)
Entity Type:Individual
Prefix:DR
First Name:MYRTLE
Middle Name:H
Last Name:MIYAMURA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 KINOOLE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2900
Mailing Address - Country:US
Mailing Address - Phone:808-935-6766
Mailing Address - Fax:
Practice Address - Street 1:475 KINOOLE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2900
Practice Address - Country:US
Practice Address - Phone:808-935-6766
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-14231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice