Individual
DR. RUSSELL S TABATA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1943 S KING ST, HONOLULU, HI 96826-2139
(800) 946-4939
Mailing address
1943 S KING ST, HONOLULU, HI 96826-2139
(800) 946-4939
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
772
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
772
HDS
HI
01
—
8637-1
HMSA
HI
Enumeration date
08/12/2006
Last updated
07/08/2007
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