Provider Demographics
NPI:1588661847
Name:MASUNAGA, RUSSELL HIROSHI (DDS)
Entity type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:HIROSHI
Last Name:MASUNAGA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2153 N KING ST
Mailing Address - Street 2:STE 322
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4559
Mailing Address - Country:US
Mailing Address - Phone:808-848-8880
Mailing Address - Fax:808-848-8814
Practice Address - Street 1:2153 N KING ST
Practice Address - Street 2:STE 322
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4559
Practice Address - Country:US
Practice Address - Phone:808-848-8880
Practice Address - Fax:808-848-8814
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HID-1711122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist