Provider Demographics
NPI:1730245804
Name:MIYASAKI, WILFRED A (DMD)
Entity type:Individual
Prefix:DR
First Name:WILFRED
Middle Name:A
Last Name:MIYASAKI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 BETHEL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2219
Mailing Address - Country:US
Mailing Address - Phone:808-533-0000
Mailing Address - Fax:808-523-1240
Practice Address - Street 1:1139 BETHEL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2219
Practice Address - Country:US
Practice Address - Phone:808-533-0000
Practice Address - Fax:808-523-1240
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice