Provider Demographics
NPI:1215151642
Name:MATSUMOTO, TERRY S (DMD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:S
Last Name:MATSUMOTO
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 1:1441 KAPIOLANI BLVD
Mailing Address - Street 2:SUITE 820
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4402
Mailing Address - Country:US
Mailing Address - Phone:808-955-8778
Mailing Address - Fax:808-955-8776
Practice Address - Street 1:1441 KAPIOLANI BLVD
Practice Address - Street 2:SUITE 820
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4402
Practice Address - Country:US
Practice Address - Phone:808-955-8778
Practice Address - Fax:808-955-8776
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9251223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIJ0016483OtherHMSA
HI1575781OtherUNITED CONCORDIA