Provider Demographics
NPI:1679620314
Name:HIROTA-TULIKIHIHIFO, JENNIFER H (DDS)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:H
Last Name:HIROTA-TULIKIHIHIFO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:HIROTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2229 NORTH SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819
Mailing Address - Country:US
Mailing Address - Phone:808-791-9428
Mailing Address - Fax:808-848-0979
Practice Address - Street 1:2229 NORTH SCHOOL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:808-791-9428
Practice Address - Fax:808-848-0979
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2152122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI00B0258810OtherHMSA
HI215202OtherHDS
HI00992101Medicaid