Provider Demographics
NPI:1902845514
Name:MIYAMURA, MYRTLE H (DMD)
Entity type:Individual
Prefix:DR
First Name:MYRTLE
Middle Name:H
Last Name:MIYAMURA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PAUAHI ST STE 203
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3047
Mailing Address - Country:US
Mailing Address - Phone:808-990-8585
Mailing Address - Fax:
Practice Address - Street 1:120 PAUAHI ST STE 203
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3047
Practice Address - Country:US
Practice Address - Phone:808-935-6766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2024-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
HIDT-14231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer