Healthcare Provider Details

I. General information

NPI: 1255711784
Provider Name (Legal Business Name): OHANA ENDODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2015
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 GARTLEY PL
HONOLULU HI
96817-1016
US

IV. Provider business mailing address

31 E LANIKAULA ST SUITE C
HILO HI
96720-4362
US

V. Phone/Fax

Practice location:
  • Phone: 808-561-2790
  • Fax:
Mailing address:
  • Phone: 808-561-2790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDT 2365
License Number StateHI

VIII. Authorized Official

Name: DR. PATRICK JOHN MUNLEY
Title or Position: MEMBER
Credential: DMD, MS
Phone: 808-561-2790