Healthcare Provider Details

I. General information

NPI: 1689818023
Provider Name (Legal Business Name): TERRENCE PATRICK CODINGTON D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2009
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75-1028 HENRY ST SUITE 102
KAILUA KONA HI
96740-1693
US

IV. Provider business mailing address

500 ALA MOANA BLVD SUITE 7-220
HONOLULU HI
96813-4920
US

V. Phone/Fax

Practice location:
  • Phone: 808-329-0025
  • Fax: 808-329-4164
Mailing address:
  • Phone: 808-523-3101
  • Fax: 808-523-3122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number1946
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: