Healthcare Provider Details

I. General information

NPI: 1023687324
Provider Name (Legal Business Name): JESSICA ROSE VO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98-1268 KAAHUMANU ST
PEARL CITY HI
96782-3257
US

IV. Provider business mailing address

2525 DATE ST APT 2103
HONOLULU HI
96826-5413
US

V. Phone/Fax

Practice location:
  • Phone: 808-486-4746
  • Fax:
Mailing address:
  • Phone: 808-693-5824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDT-2909
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT-2909
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: