Provider Demographics
NPI:1750379756
Name:MATSUSHIMA II, MICHAEL MINORU (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MINORU
Last Name:MATSUSHIMA II
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1580 MAKALOA ST
Mailing Address - Street 2:SUITE 717
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3216
Mailing Address - Country:US
Mailing Address - Phone:808-947-3212
Mailing Address - Fax:808-947-3212
Practice Address - Street 1:1580 MAKALOA ST
Practice Address - Street 2:SUITE 717
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3216
Practice Address - Country:US
Practice Address - Phone:808-947-3212
Practice Address - Fax:808-947-3212
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI10221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice