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General NPI Number Information
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NPI Number | 1285865170
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Entity Type | Organization
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Legal Business Name | SWEET TOOTH DENTAL INC.
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Dates
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Enumeration Date | 07/27/2009
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Last Update Date | 07/27/2009
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Provider Practice Location Address
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Address Line | 75-5660 KOPIKO ST STE B2
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City | KAILUA KONA
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State | HI
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Zip | 96740-3121
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Country | US
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Telephone | 808-329-0889
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Fax | 808-329-5062
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Provider Business Mailing Address
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Address Line | 75-5660 KOPIKO ST STE B2
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City | KAILUA KONA
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State | HI
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Zip | 96740-3121
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Country | US
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Telephone | 808-329-0889
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Fax | 808-329-5062
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. GARRETT B.K. OKA
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Credential | DDS
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Telephone | 808-329-0889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 1987-01
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License Number State | HI
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