Provider Demographics
NPI:1285711424
Name:TOKUNAGA FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:TOKUNAGA FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MODESTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAERLAN-TOKUNAGA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-689-7964
Mailing Address - Street 1:91-902 FORT WEAVER RD STE 208
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-2261
Mailing Address - Country:US
Mailing Address - Phone:808-689-7964
Mailing Address - Fax:808-689-0909
Practice Address - Street 1:91-902 FORT WEAVER RD STE 208
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-2261
Practice Address - Country:US
Practice Address - Phone:808-689-7964
Practice Address - Fax:808-689-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 1529261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI041315Medicaid