Healthcare Provider Details

I. General information

NPI: 1205089745
Provider Name (Legal Business Name): GINELLE A SAKIMA ROBERTS D.D.S., M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81-6627 MAMALAHOA HWY SUITE 106
KEALAKEKUA HI
96750-8180
US

IV. Provider business mailing address

75-5751 KUAKINI HWY SUITE 203
KAILUA KONA HI
96740-1752
US

V. Phone/Fax

Practice location:
  • Phone: 808-322-8005
  • Fax: 808-329-5057
Mailing address:
  • Phone: 808-322-8005
  • Fax: 808-329-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberCSDT 036
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: