Healthcare Provider Details

I. General information

NPI: 1164280756
Provider Name (Legal Business Name): DENTAL ARTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-1099 AINAMAKUA DR STE 1
MILILANI HI
96789-4298
US

IV. Provider business mailing address

95-1099 AINAMAKUA DR STE 1
MILILANI HI
96789-4298
US

V. Phone/Fax

Practice location:
  • Phone: 808-625-6300
  • Fax: 808-623-6810
Mailing address:
  • Phone: 808-625-6300
  • Fax: 808-623-6810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BAYSA
Title or Position: OWNER/MEMBER
Credential: DDS
Phone: 808-625-6300