Provider Demographics
NPI:1649722547
Name:DENTAL TECHNOLOGY CENTER OF HAWAII LLC
Entity type:Organization
Organization Name:DENTAL TECHNOLOGY CENTER OF HAWAII LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WADE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAKENISHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-291-2254
Mailing Address - Street 1:1314 S KING ST STE 724
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1942
Mailing Address - Country:US
Mailing Address - Phone:808-291-2254
Mailing Address - Fax:
Practice Address - Street 1:1314 S KING ST STE 724
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1942
Practice Address - Country:US
Practice Address - Phone:808-291-2254
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization