Provider Demographics
NPI:1023083540
Name:SUEHISA, INEZ HANAKO (DMD)
Entity type:Individual
Prefix:DR
First Name:INEZ
Middle Name:HANAKO
Last Name:SUEHISA
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 1:95-441 AWIKI ST
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1857
Mailing Address - Country:US
Mailing Address - Phone:808-627-1656
Mailing Address - Fax:
Practice Address - Street 1:302 CALIFORNIA AVE
Practice Address - Street 2:204
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1841
Practice Address - Country:US
Practice Address - Phone:808-622-2633
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-19751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice