Healthcare Provider Details

I. General information

NPI: 1538219910
Provider Name (Legal Business Name): STEVEN WONDERLICH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 ALA MOANA BLVD SUITE 7-300
HONOLULU HI
96813-4920
US

IV. Provider business mailing address

500 ALA MOANA BLVD SUITE 7-220
HONOLULU HI
96813-4920
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-4332
  • Fax: 808-537-6640
Mailing address:
  • Phone: 808-523-3103
  • Fax: 808-523-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDT-2023
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: