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General NPI Number Information
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NPI Number | 1023742905
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Entity Type | Organization
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Legal Business Name | HAWAII PEDIATRIC DENTISTRY LLC
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 91-3575 KAULUAKOKO ST UNIT 3004
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City | EWA BEACH
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State | HI
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Zip | 96706-5857
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Country | US
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Telephone | 781-951-4055
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Fax |
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Provider Business Mailing Address
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Address Line | 91-3575 KAULUAKOKO ST UNIT 3004
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City | EWA BEACH
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State | HI
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Zip | 96706-5857
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Country | US
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Telephone | 781-951-4055
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Fax |
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Authorized Official
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Title or Position | OWNER/PEDIATRIC DENTIST
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Name | DR. PETER LEE
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Credential | DMD
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Telephone | 808-753-9094
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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