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General NPI Number Information
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NPI Number | 1326454208
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Entity Type | Organization
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Legal Business Name | DIAMOND HEAD DENTAL CARE
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Dates
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Enumeration Date | 07/11/2014
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Last Update Date | 07/11/2014
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Provider Practice Location Address
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Address Line | 3045 MONSARRAT AVE UNIT 7
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City | HONOLULU
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State | HI
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Zip | 96815-4400
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Country | US
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Telephone | 808-735-8883
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Fax |
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Provider Business Mailing Address
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Address Line | 3045 MONSARRAT AVE UNIT 7
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City | HONOLULU
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State | HI
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Zip | 96815-4400
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Country | US
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Telephone | 808-735-8883
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. DAVID MATTO
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Credential | DMD
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Telephone | 808-286-1714
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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 | 2155
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License Number State | HI
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