Healthcare Provider Details

I. General information

NPI: 1457430472
Provider Name (Legal Business Name): GREG T HURTADO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-1221 KA UKA BLVD SUITE 201
WAIPAHU HI
96797-6202
US

IV. Provider business mailing address

94-1221 KA UKA BLVD SUITE 201
WAIPAHU HI
96797-6202
US

V. Phone/Fax

Practice location:
  • Phone: 808-678-3000
  • Fax: 808-678-0555
Mailing address:
  • Phone: 808-678-3000
  • Fax: 808-678-0555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT1800
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: