Healthcare Provider Details

I. General information

NPI: 1023018033
Provider Name (Legal Business Name): JUDY QUENGUA-BONDOCOY D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-300 FARRINGTON HWY G-16
WAIPAHU HI
96797-2648
US

IV. Provider business mailing address

91-277 KAIELEELE PL
EWA BEACH HI
96706-4617
US

V. Phone/Fax

Practice location:
  • Phone: 808-680-7800
  • Fax:
Mailing address:
  • Phone: 808-685-8175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT-1968
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: