Healthcare Provider Details

I. General information

NPI: 1487094637
Provider Name (Legal Business Name): HAWAII PROSTHODONTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 07/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 WARD AVE STE 820
HONOLULU HI
96814-1617
US

IV. Provider business mailing address

1100 WARD AVE STE 820
HONOLULU HI
96814-1617
US

V. Phone/Fax

Practice location:
  • Phone: 808-531-3003
  • Fax: 808-524-6866
Mailing address:
  • Phone: 808-531-3003
  • Fax: 808-524-6866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number1335
License Number StateHI

VIII. Authorized Official

Name: DR. DUANE T FUJII
Title or Position: OWNER/MEMBER
Credential: DDS
Phone: 808-531-3003