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General NPI Number Information
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NPI Number | 1083094601
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Entity Type | Organization
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Legal Business Name | LYLE T. TENJOMA DDS, MSD
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Dates
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Enumeration Date | 06/09/2015
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 91-902 FORT WEAVER RD STE 208
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City | EWA BEACH
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State | HI
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Zip | 96706-2261
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Country | US
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Telephone | 808-689-7964
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Fax |
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Provider Business Mailing Address
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Address Line | 91-902 FORT WEAVER RD STE 208
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City | EWA BEACH
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State | HI
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Zip | 96706-2261
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Country | US
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Telephone | 808-689-7964
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LYLE T. TENJOMA
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Credential | DDS, MSD
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Telephone | 808-941-4511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1262
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License Number State | HI
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