Healthcare Provider Details

I. General information

NPI: 1104667906
Provider Name (Legal Business Name): PUALANI DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2024
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 ULUNIU ST STE 114
KAILUA HI
96734-2531
US

IV. Provider business mailing address

1391 KAPIOLANI BLVD APT 1101
HONOLULU HI
96814-4584
US

V. Phone/Fax

Practice location:
  • Phone: 808-633-1207
  • Fax:
Mailing address:
  • Phone: 808-633-1207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT W LEONARD
Title or Position: PRESIDENT
Credential: DDS
Phone: 808-633-1207