Healthcare Provider Details

I. General information

NPI: 1730318270
Provider Name (Legal Business Name): HAWAII ENDODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 05/08/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 AULIKE ST SUITE 404
HONOLULU HI
96734
US

IV. Provider business mailing address

30 AULIKE ST SUITE 404
HONOLULU HI
96734
US

V. Phone/Fax

Practice location:
  • Phone: 808-235-3131
  • Fax: 808-234-0127
Mailing address:
  • Phone: 808-235-3131
  • Fax: 808-234-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2093
License Number StateHI

VIII. Authorized Official

Name: JENNY GARCIA-ROCHA
Title or Position: SENIOR CREDENTIALING TEAM LEAD
Credential:
Phone: 972-869-3789