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General NPI Number Information
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NPI Number | 1295108280
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Entity Type | Organization
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Legal Business Name | ISLAND DENTAL GROUP INC
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Dates
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Enumeration Date | 11/12/2015
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 98-1247 KAAHUMANU ST SUITE 214
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City | AIEA
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State | HI
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Zip | 96701-5311
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Country | US
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Telephone | 808-484-4470
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Fax | 808-484-4462
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Provider Business Mailing Address
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Address Line | 98-1247 KAAHUMANU ST SUITE 214
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City | AIEA
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State | HI
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Zip | 96701-5311
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Country | US
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Telephone | 808-484-4470
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Fax | 808-484-4462
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. CLAUDE NOBORU TAMURA
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Credential | D.D.S.
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Telephone | 808-484-4470
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DT 1744
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License Number State | HI
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