Healthcare Provider Details

I. General information

NPI: 1114902939
Provider Name (Legal Business Name): HEATHER LYNN STEIN DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 MAKALAPA GATE RD
PEARL HARBOR HI
96860-4479
US

IV. Provider business mailing address

159 KAILUANA LOOP
KAILUA HI
96734-1660
US

V. Phone/Fax

Practice location:
  • Phone: 808-473-0495
  • Fax:
Mailing address:
  • Phone: 808-473-0495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7271
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: