Healthcare Provider Details

I. General information

NPI: 1427363571
Provider Name (Legal Business Name): RICHARD A RASMUSSEN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2010
Last Update Date: 08/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1063 L OWER MAIN ST STE C221
WAILUKU HI
96793
US

IV. Provider business mailing address

1063 L OWER MAIN ST STE C221
WAILUKU HI
96793
US

V. Phone/Fax

Practice location:
  • Phone: 808-244-7634
  • Fax: 808-242-2851
Mailing address:
  • Phone: 808-244-7634
  • Fax: 808-242-2851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number926
License Number StateHI

VIII. Authorized Official

Name: DR. RICHARD A RASMUSSEN
Title or Position: ORAL SURGEON
Credential: DDS
Phone: 808-244-7634