1730123050 NPI number — DENTAL CARE CENTERS OF HAWAII, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730123050 NPI number — DENTAL CARE CENTERS OF HAWAII, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DENTAL CARE CENTERS OF HAWAII, 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:
GENTLE DENTAL (AEIA/PEARLRIDGE)
Provider Other Organization Name Type Code:
3
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:
1730123050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 SE TECH CENTER DRIVE
Provider Second Line Business Mailing Address:
STE 195
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98683-5511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-869-7645
Provider Business Mailing Address Fax Number:
866-227-5633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
98-211 PALI MOMI ST
Provider Second Line Business Practice Location Address:
STE 715
Provider Business Practice Location Address City Name:
AIEA
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96701-4339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-488-8119
Provider Business Practice Location Address Fax Number:
808-487-6194
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZANT
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PC PRESIDENT
Authorized Official Telephone Number:
360-869-7645

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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