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General NPI Number Information
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NPI Number | 1285978296
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Entity Type | Organization
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Legal Business Name | PUNAHOU DENTAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 11/15/2012
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Last Update Date | 11/15/2012
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Provider Practice Location Address
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Address Line | 900 PUNAHOU ST STE 201
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City | HONOLULU
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State | HI
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Zip | 96826-2500
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Country | US
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Telephone | 808-947-1323
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Fax | 808-947-8902
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Provider Business Mailing Address
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Address Line | 900 PUNAHOU ST STE 201
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City | HONOLULU
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State | HI
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Zip | 96826-2500
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Country | US
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Telephone | 808-947-1323
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Fax | 808-947-8902
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Authorized Official
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Title or Position | MEMBER
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Name | DR. GEORGE WESSBERG
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Credential | D.D.S.
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Telephone | 808-223-2731
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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 | 1309
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License Number State | HI
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