Provider Demographics
NPI:1215481379
Name:DEAN T. SUEDA D.D.S., M.S. INC
Entity type:Organization
Organization Name:DEAN T. SUEDA D.D.S., M.S. INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:808-944-1020
Mailing Address - Street 1:4450 KAPOLEI PARKWAY
Mailing Address - Street 2:#570
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707
Mailing Address - Country:US
Mailing Address - Phone:808-944-1020
Mailing Address - Fax:808-944-1030
Practice Address - Street 1:4450 KAPOLEI PARKWAY
Practice Address - Street 2:#570
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707
Practice Address - Country:US
Practice Address - Phone:808-944-1020
Practice Address - Fax:808-944-1030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEAN T. SUEDA, D.D.S., M.S. INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-06
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10661223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty