Healthcare Provider Details

I. General information

NPI: 1275776189
Provider Name (Legal Business Name): EDMUND A. CASSELLA DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 KAPIOLANI BLVD STE 1506
HONOLULU HI
96814-4407
US

IV. Provider business mailing address

1441 KAPIOLANI BLVD STE 1506
HONOLULU HI
96814-4407
US

V. Phone/Fax

Practice location:
  • Phone: 808-955-1506
  • Fax: 808-955-1551
Mailing address:
  • Phone: 808-955-1506
  • Fax: 808-955-1551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number1748
License Number StateHI

VIII. Authorized Official

Name: DR. EDMUND A. CASSELLA
Title or Position: OWNER
Credential: DMD
Phone: 808-955-1506