Healthcare Provider Details

I. General information

NPI: 1144766486
Provider Name (Legal Business Name): HONU SMILES PEDIATRIC DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2017
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95-1105 AINAMAKUA DR #202
MILILANI HI
96789-6313
US

IV. Provider business mailing address

95-1105 AINAMAKUA DR #202
MILILANI HI
96789-6313
US

V. Phone/Fax

Practice location:
  • Phone: 206-291-8879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDT-2543
License Number StateHI

VIII. Authorized Official

Name: JOHN WILLIAM CHANG
Title or Position: DENTIST
Credential: DDS
Phone: 808-221-2367