=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346737202
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DENTISTRY FOR CHILDREN INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2018
-----------------------------------------------------
Last Update Date | 04/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1319 PUNAHOU STREET SUITE 1080
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-949-8411
-----------------------------------------------------
Fax | 808-947-6262
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1319 PUNAHOU STREET SUITE 1080
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-949-8411
-----------------------------------------------------
Fax | 808-947-6262
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | BRENT CHING
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 808-949-8411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | DT-1960
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------