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General NPI Number Information
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NPI Number | 1285948059
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Entity Type | Organization
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Legal Business Name | SPECIAL CARE DENTISTRY, LLC
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Dates
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Enumeration Date | 08/03/2010
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Last Update Date | 11/24/2014
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Provider Practice Location Address
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Address Line | 56 EHIKU LOOP STE 2
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City | KIHEI
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State | HI
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Zip | 96753-5612
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Country | US
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Telephone | 808-633-6931
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Fax | 888-222-3530
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Provider Business Mailing Address
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Address Line | PO BOX 539
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City | KIHEI
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State | HI
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Zip | 96753-0539
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Country | US
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Telephone | 808-633-6931
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Fax | 888-222-3530
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Authorized Official
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Title or Position | DENTIST
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Name | DR. SONIA GUPTA
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Credential | D.D.S.
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Telephone | 808-633-6931
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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 | DT2386
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License Number State | HI
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