Healthcare Provider Details

I. General information

NPI: 1588698450
Provider Name (Legal Business Name): RONY ESCOBAR DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-1028 HENRY ST SUITE 203
KAILUA KONA HI
96740-1693
US

IV. Provider business mailing address

555 W BENJAMIN HOLT DR BUILDING B
STOCKTON CA
95207-3839
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-4425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1978
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: