Healthcare Provider Details

I. General information

NPI: 1235339839
Provider Name (Legal Business Name): ROBERT L. ORNELLES, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2007
Last Update Date: 07/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 S KING ST STE 307
HONOLULU HI
96814-1951
US

IV. Provider business mailing address

1150 S KING ST STE 307
HONOLULU HI
96814-1951
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 Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDT-1735
License Number StateHI

VIII. Authorized Official

Name: DR. ROBERT L. ORNELLES
Title or Position: SOLE MEMBER, LLC
Credential: DDS
Phone: 808-596-2851