Provider Demographics
NPI:1942535471
Name:MYLES C. MIYASATO, D.D.S., M.S.,INC.
Entity Type:Organization
Organization Name:MYLES C. MIYASATO, D.D.S., M.S.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MYLES
Authorized Official - Middle Name:CLAYTON
Authorized Official - Last Name:MIYASATO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:808-488-5880
Mailing Address - Street 1:98-1247 KAAHUMANU ST STE 316
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5301
Mailing Address - Country:US
Mailing Address - Phone:808-488-5880
Mailing Address - Fax:808-488-5882
Practice Address - Street 1:98-1247 KAAHUMANU ST STE 316
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5301
Practice Address - Country:US
Practice Address - Phone:808-488-5880
Practice Address - Fax:808-488-5882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-16
Last Update Date:2009-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIHI9411223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty