Healthcare Provider Details

I. General information

NPI: 1881744464
Provider Name (Legal Business Name): ROBERT L ORNELLES D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S KING ST SUITE 307
HONOLULU HI
96814-1922
US

IV. Provider business mailing address

1150 S KING ST SUITE 307
HONOLULU HI
96814-1922
US

V. Phone/Fax

Practice location:
  • Phone: 808-596-2851
  • Fax: 808-593-8868
Mailing address:
  • Phone: 808-596-2851
  • Fax: 808-593-8868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT-1735
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: