Healthcare Provider Details

I. General information

NPI: 1942525068
Provider Name (Legal Business Name): RAYMOND K.L. LOO, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 S BERETANIA ST SUITE 305
HONOLULU HI
96813-2551
US

IV. Provider business mailing address

848 S BERETANIA ST SUITE 305
HONOLULU HI
96813-2551
US

V. Phone/Fax

Practice location:
  • Phone: 808-524-1102
  • Fax:
Mailing address:
  • Phone: 808-524-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number910
License Number StateHI

VIII. Authorized Official

Name: DR. RAYMOND K.L. LOO
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 808-524-1102