Healthcare Provider Details

I. General information

NPI: 1891180287
Provider Name (Legal Business Name): DR. DON SAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2015
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54-135 HONOMU PL
HAUULA HI
96717-9616
US

IV. Provider business mailing address

54-135 HONOMU PL
HAUULA HI
96717-9616
US

V. Phone/Fax

Practice location:
  • Phone: 808-428-1572
  • Fax:
Mailing address:
  • Phone: 808-428-1572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number35354
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number35354
License Number StateCA

VIII. Authorized Official

Name: DR. DON B SAND
Title or Position: DENTIST
Credential: DDS
Phone: 808-428-1572