Provider Demographics
NPI:1245667070
Name:GLENN M. OKIHIRO, D.D.S., INC.
Entity type:Organization
Organization Name:GLENN M. OKIHIRO, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:M
Authorized Official - Last Name:OKIHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-455-4173
Mailing Address - Street 1:850 KAMEHAMEHA HWY STE 116
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2603
Mailing Address - Country:US
Mailing Address - Phone:808-455-4173
Mailing Address - Fax:808-455-3280
Practice Address - Street 1:850 KAMEHAMEHA HWY STE 116
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2603
Practice Address - Country:US
Practice Address - Phone:808-455-4173
Practice Address - Fax:808-455-3280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty