=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053461434
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALAN TOM DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/10/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 95 LONO AVE STE 210
-----------------------------------------------------
City | KAHULUI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96732-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-877-5328
-----------------------------------------------------
Fax | 808-877-3496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 ALA MOANA BLVD
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-4920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-523-3103
-----------------------------------------------------
Fax | 808-523-3122
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223X0400X
-----------------------------------------------------
Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
-----------------------------------------------------
License Number | DT-944
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------