Provider Demographics
NPI:1942391438
Name:LAPORTE, BRYANT B (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYANT
Middle Name:B
Last Name:LAPORTE
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 1:1123 11TH AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2433
Mailing Address - Country:US
Mailing Address - Phone:808-732-8811
Mailing Address - Fax:
Practice Address - Street 1:1123 11TH AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-2433
Practice Address - Country:US
Practice Address - Phone:808-732-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI02526601Medicaid
HIE2812-5OtherHMSA