Healthcare Provider Details

I. General information

NPI: 1932443793
Provider Name (Legal Business Name): OAHU ORTHODONTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 11/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3221 WAIALAE AVE STE 370
HONOLULU HI
96816-5842
US

IV. Provider business mailing address

3221 WAIALAE AVE STE 370
HONOLULU HI
96816-5842
US

V. Phone/Fax

Practice location:
  • Phone: 312-404-5393
  • Fax:
Mailing address:
  • Phone: 312-404-5393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDT-2464
License Number StateHI

VIII. Authorized Official

Name: DR. ROSEMARIE TAN
Title or Position: ORTHODONTIST
Credential: DDS
Phone: 312-404-5393