Healthcare Provider Details

I. General information

NPI: 1821215443
Provider Name (Legal Business Name): OAK'S DENTAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 S KING ST STE 401
HONOLULU HI
96814-2669
US

IV. Provider business mailing address

1481 S KING ST STE 401
HONOLULU HI
96814-2669
US

V. Phone/Fax

Practice location:
  • Phone: 808-946-2875
  • Fax: 808-955-9709
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number1768
License Number StateHI

VIII. Authorized Official

Name: DR. SUNNAM OAK
Title or Position: DENTIST
Credential: DDS
Phone: 808-946-2875