Individual
LEESA S MIYASATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
65-1230 MAMALAHOA HWY STE E21, KAMUELA, HI 96743-8319
(808) 887-8801
(808) 887-8805
Mailing address
65-1230 MAMALAHOA HWY STE E21, KAMUELA, HI 96743-8319
(808) 887-8801
(808) 887-8805
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DT1389
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138901
HDS PROVIDER NUMBER
HI
01
—
B-06401-0
HMSA PROVIDER NUMBER
HI
Enumeration date
09/24/2006
Last updated
07/08/2007
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