Healthcare Provider Details

I. General information

NPI: 1164654687
Provider Name (Legal Business Name): ROBERT M ATEBARA, DMD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 PONAHAWAI ST SUITE 202
HILO HI
96720-3074
US

IV. Provider business mailing address

275 PONAHAWAI ST SUITE 202
HILO HI
96720-3074
US

V. Phone/Fax

Practice location:
  • Phone: 808-961-3031
  • Fax:
Mailing address:
  • Phone: 808-961-3031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number901
License Number StateHI

VIII. Authorized Official

Name: DR. ROBERT M ATEBARA
Title or Position: PRESIDENT
Credential: DMD
Phone: 808-961-3031