Provider Demographics
NPI:1457430985
Name:GAERLAN-TOKUNAGA, MODESTA (DDS)
Entity Type:Individual
Prefix:
First Name:MODESTA
Middle Name:
Last Name:GAERLAN-TOKUNAGA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-307 FARRINGTON HWY STE A10
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2500
Mailing Address - Country:US
Mailing Address - Phone:808-671-9166
Mailing Address - Fax:808-671-6236
Practice Address - Street 1:94-307 FARRINGTON HWY STE A10
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2500
Practice Address - Country:US
Practice Address - Phone:808-671-9166
Practice Address - Fax:808-671-6236
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 15291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI041315Medicaid