Healthcare Provider Details

I. General information

NPI: 1710739867
Provider Name (Legal Business Name): SKPD 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94-229 WAIPAHU DEPOT ST STE 501
WAIPAHU HI
96797-3035
US

IV. Provider business mailing address

94-229 WAIPAHU DEPOT ST STE 501
WAIPAHU HI
96797-3035
US

V. Phone/Fax

Practice location:
  • Phone: 808-671-0055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: AUDREY MAE NAVARRO RAWSON
Title or Position: OWNER
Credential: DDS
Phone: 808-312-0254