Healthcare Provider Details

I. General information

NPI: 1912632944
Provider Name (Legal Business Name): BIG ISLAND ORAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2022
Last Update Date: 07/22/2022
Certification Date: 07/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 PUUHONU WAY
HILO HI
96720-2069
US

IV. Provider business mailing address

135 PUUHONU WAY
HILO HI
96720-2069
US

V. Phone/Fax

Practice location:
  • Phone: 732-822-7500
  • Fax:
Mailing address:
  • Phone: 732-822-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. BENJAMIN ISADORE ROTWEIN
Title or Position: OWNER/SURGEON
Credential: DMD
Phone: 732-822-7500