Provider Demographics
NPI:1336271857
Name:KADOHIRO, GLENN Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:Y
Last Name:KADOHIRO
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 1:154 PAPALAUA ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96761-1616
Mailing Address - Country:US
Mailing Address - Phone:808-667-7711
Mailing Address - Fax:808-661-4562
Practice Address - Street 1:154 PAPALAUA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-1616
Practice Address - Country:US
Practice Address - Phone:808-667-7711
Practice Address - Fax:808-661-4562
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI013311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice