Provider Demographics
NPI:1922197201
Name:MASUDA, LORI A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:A
Last Name:MASUDA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 FARRINGTON HWY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2001
Mailing Address - Country:US
Mailing Address - Phone:808-674-2520
Mailing Address - Fax:808-674-8148
Practice Address - Street 1:555 FARRINGTON HWY
Practice Address - Street 2:SUITE 1
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2001
Practice Address - Country:US
Practice Address - Phone:808-674-2520
Practice Address - Fax:808-674-8148
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI18681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice