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General NPI Number Information
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NPI Number | 1134247414
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Entity Type | Organization
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Legal Business Name | ISLAND DENTISTRY, INC.
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 30 AULIKE ST SUITE 503
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City | KAILUA
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State | HI
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Zip | 96734-2707
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Country | US
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Telephone | 808-384-4579
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Fax | 808-261-1449
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Provider Business Mailing Address
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Address Line | 30 AULIKE ST SUITE 503
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City | KAILUA
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State | HI
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Zip | 96734-2707
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Country | US
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Telephone | 808-384-4579
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Fax | 808-261-1449
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LILLY LI GEYER
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Credential | DMD
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Telephone | 808-384-4579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DT2106
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License Number State | HI
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