1457643256 NPI number — DR. TAMARA CHRISTINE BEXTON D.M.D.

Table of content: DR. TAMARA CHRISTINE BEXTON D.M.D. (NPI 1457643256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457643256 NPI number — DR. TAMARA CHRISTINE BEXTON D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEXTON
Provider First Name:
TAMARA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

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:
1457643256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 790829
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAIA
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96779-0829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-283-5456
Provider Business Mailing Address Fax Number:
808-873-8097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 MAKAWAO AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
MAKAWAO
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96768-8895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-572-9461
Provider Business Practice Location Address Fax Number:
808-572-8323
Provider Enumeration Date:
05/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2428 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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