Provider Demographics
NPI:1740288695
Name:OKAZAKI, TODD R (DDS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:R
Last Name:OKAZAKI
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 1:66-125 KAMEHAMEHA HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-1420
Mailing Address - Country:US
Mailing Address - Phone:808-637-9652
Mailing Address - Fax:808-637-5688
Practice Address - Street 1:66-125 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1420
Practice Address - Country:US
Practice Address - Phone:808-637-9652
Practice Address - Fax:808-637-5688
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI16411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00207801Medicaid