1598482614 NPI number — HAWAI I MOBILE DENTAL INC

Table of content: (NPI 1598482614)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598482614 NPI number — HAWAI I MOBILE DENTAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAWAI I MOBILE DENTAL INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598482614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95-390 KUAHELANI AVE # 3AC-1193
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILILANI
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96789-1192
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-201-9273
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
95-390 KUAHELANI AVE
Provider Second Line Business Practice Location Address:
3AC-1193
Provider Business Practice Location Address City Name:
MILILANI
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96789-1192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-201-9273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HAWKINS
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
THOMAS-TERROLL
Authorized Official Title or Position:
GENERAL DENTIST/PRESIDENT
Authorized Official Telephone Number:
808-201-9273

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15743316 . This is a "ADA CREDENTIALLING PORTAL: CAQH" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".