Healthcare Provider Details

I. General information

NPI: 1720304090
Provider Name (Legal Business Name): ISLAND ENDODONTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 04/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD SUITE 820
HONOLULU HI
96814-4402
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD SUITE 820
HONOLULU HI
96814-4402
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-8778
  • Fax: 808-955-8776
Mailing address:
  • Phone: 808-955-8778
  • Fax: 808-955-8776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number925
License Number StateHI

VIII. Authorized Official

Name: TERRY S. MATSUMOTO
Title or Position: OWNER
Credential: DMD
Phone: 808-955-8778