Healthcare Provider Details

I. General information

NPI: 1336795079
Provider Name (Legal Business Name): BRIAN PETER NADEAU DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 CENTRAL AVE
PEARL HARBOR HI
96860-4908
US

IV. Provider business mailing address

480 CENTRAL AVE
JBPHH HI
96860-4908
US

V. Phone/Fax

Practice location:
  • Phone: 413-221-8386
  • Fax:
Mailing address:
  • Phone: 413-221-8386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN1858403
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDT-3326
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: