Active NPI
Brice H Takata, D.D.S.
- Pediatric Dentistry
- Hilo, HI
National Provider Identifier
1164572764
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 2102
- Practice address
- 445 Waianuenue Ave
Hilo, HI 96720-2535 - Phone
- (808) 935-3351
- NPI assigned
- Jan 12, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 2102 | HI | Primary |
Addresses
Primary practice location
445 Waianuenue Ave
Hilo, HI 96720-2535
Mailing address
445 Waianuenue Ave
Hilo, HI 96720-2535
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 25499-5 | Other | HI | HMSA |
| 2102 | Other | HI | HAWAII DENTAL SERVICE |
| 56345201 | Medicaid | HI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2102 | HI | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Takata Dental Health Center, Inc. | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Hilo, HI
- NPI 1285785824
Pediatric Dentistry
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168560000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1164572764",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "445 WAIANUENUE AVE",
"city": "HILO",
"state": "HI",
"postal_code": "967202535"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "445 WAIANUENUE AVE",
"city": "HILO",
"state": "HI",
"postal_code": "967202535",
"telephone_number": "808-935-3351"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAKATA",
"first_name": "BRICE",
"middle_name": "H",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "HI",
"license": "2102",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HMSA",
"identifier": "25499-5",
"state": "HI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HAWAII DENTAL SERVICE",
"identifier": "2102",
"state": "HI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "56345201",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hilo, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.