Provider Demographics
NPI:1255454575
Name:TANAKA, RAYMOND HIDEO (DDS)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:HIDEO
Last Name:TANAKA
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 1:98211 PALI MOMI ST
Mailing Address - Street 2:SUITE 705
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-4377
Mailing Address - Country:US
Mailing Address - Phone:808-488-3288
Mailing Address - Fax:808-488-6925
Practice Address - Street 1:98211 PALI MOMI ST
Practice Address - Street 2:SUITE 705
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4377
Practice Address - Country:US
Practice Address - Phone:808-488-3288
Practice Address - Fax:808-488-6925
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice