Healthcare Provider Details

I. General information

NPI: 1780792275
Provider Name (Legal Business Name): HAWAII ENDODONTICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 S BERETANIA ST STE 301
HONOLULU HI
96813-2551
US

IV. Provider business mailing address

848 S BERETANIA ST STE 301
HONOLULU HI
96813-2551
US

V. Phone/Fax

Practice location:
  • Phone: 808-536-3963
  • Fax: 808-533-4906
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: LAWRENCE K. NITTA
Title or Position: PRESIDENT
Credential:
Phone: 808-536-3963