Provider Demographics
NPI:1912082348
Name:TANABE GOO, JULIE T (DDS)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:T
Last Name:TANABE GOO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:T
Other - Last Name:TANABE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3538 WAIALAE AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-2742
Mailing Address - Country:US
Mailing Address - Phone:808-734-8969
Mailing Address - Fax:808-737-2634
Practice Address - Street 1:3538 WAIALAE AVE STE 206
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-2742
Practice Address - Country:US
Practice Address - Phone:808-734-8969
Practice Address - Fax:808-737-2634
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-18911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1891OtherHDS PROVIDER NO.
HIDT 1891OtherSTATE DENTIST LICENSE NO.
HI208538OtherHMSA PROVIDER NO.