Provider Demographics
NPI:1245643667
Name:TAKEMOTO, MARY JANE DR
Entity type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:DR
Last Name:TAKEMOTO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARY JANE
Other - Middle Name:DR
Other - Last Name:TUVERA-TALEMOTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDH
Mailing Address - Street 1:4323 LAAKEA ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-1966
Mailing Address - Country:US
Mailing Address - Phone:808-422-4420
Mailing Address - Fax:
Practice Address - Street 1:1253 MAKALAPA GATE RD
Practice Address - Street 2:
Practice Address - City:JBPHH
Practice Address - State:HI
Practice Address - Zip Code:96860-4479
Practice Address - Country:US
Practice Address - Phone:808-473-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDH-1027124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist