Healthcare Provider Details

I. General information

NPI: 1144634577
Provider Name (Legal Business Name): JAMES HENRY MARTINEAU D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2014
Last Update Date: 03/23/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MONTGOMERY DRIVE #339 FORT SHAFTER
HONOLULU HI
96818
US

IV. Provider business mailing address

6791 NUHOLANI ST
HONOLULU HI
96818-7071
US

V. Phone/Fax

Practice location:
  • Phone: 88-438-5555
  • Fax:
Mailing address:
  • Phone: 801-510-8625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDT-2945
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: