Healthcare Provider Details

I. General information

NPI: 1588060594
Provider Name (Legal Business Name): PRINCEVILLE DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5-4280 KUHIO HWY SUITE 220
PRINCEVILLE HI
96722-5451
US

IV. Provider business mailing address

PO BOX 223466
PRINCEVILLE HI
96722-3466
US

V. Phone/Fax

Practice location:
  • Phone: 808-212-1806
  • Fax: 808-212-1825
Mailing address:
  • Phone: 808-212-1806
  • Fax: 808-212-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT2348
License Number StateHI

VIII. Authorized Official

Name: DR. THOMAS ATKIN
Title or Position: DENTIST
Credential: DMD
Phone: 808-212-1806