Healthcare Provider Details

I. General information

NPI: 1770749285
Provider Name (Legal Business Name): ENDODONTIC ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD. #208
HONOLULU HI
96814
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD. #208
HONOLULU HI
96814
US

V. Phone/Fax

Practice location:
  • Phone: 808-591-1515
  • Fax: 808-593-8628
Mailing address:
  • Phone: 808-591-1515
  • Fax: 808-593-8628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberW6864469701
License Number StateHI

VIII. Authorized Official

Name: ADAM INABA
Title or Position: ENDODONTIST
Credential: DDS
Phone: 808-591-1515