1568503258 NPI number — CHILDREN'S DENTAL ASSOCIATES, INC.

Table of content: (NPI 1568503258)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568503258 NPI number — CHILDREN'S DENTAL ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S DENTAL ASSOCIATES, 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:
1568503258
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1314 S KING ST
Provider Second Line Business Mailing Address:
SUITE 618
Provider Business Mailing Address City Name:
HONOLULU
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96814-1956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
808-596-9889
Provider Business Mailing Address Fax Number:
808-596-9892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94-673 KUPUOHI ST
Provider Second Line Business Practice Location Address:
SUITE C103
Provider Business Practice Location Address City Name:
WAIPAHU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96797-5367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-680-0097
Provider Business Practice Location Address Fax Number:
808-680-0031
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OSHIRO
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCIAL COORDINATOR
Authorized Official Telephone Number:
808-680-0097

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 206901 . This is a "HDS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 199801 . This is a "HDS" identifier . This identifiers is of the category "OTHER".




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