Individual
DR. CORY K WAKANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
120 PAUAHI ST, SUITE 204, HILO, HI 96720-3067
(808) 961-5617
(808) 935-3290
Mailing address
120 PAUAHI ST, SUITE 204, HILO, HI 96720-3067
(808) 961-5617
(808) 935-3290
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DT-1796
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1796
HDS
HI
05
—
24540901
—
HI
01
—
A9256-7
HMSA
HI
Enumeration date
01/09/2007
Last updated
07/08/2007
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