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General NPI Number Information
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NPI Number | 1356492003
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Entity Type | Organization
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Legal Business Name | FAMILY DENTAL CLINIC, INC.
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1210 DILLINGHAM BLVD SUITE 12
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City | HONOLULU
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State | HI
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Zip | 96817-4436
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Country | US
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Telephone | 808-847-1225
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Fax | 808-847-1226
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Provider Business Mailing Address
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Address Line | 1210 DILLINGHAM BLVD SUITE 12
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City | HONOLULU
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State | HI
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Zip | 96817-4436
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Country | US
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Telephone | 808-847-1225
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Fax | 808-847-1226
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Authorized Official
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Title or Position | GENERAL DENTISTRY
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Name | DR. MARIA PORMENTO ADORA
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Credential | D.M.D.
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Telephone | 808-847-1225
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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 | DT1882
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License Number State | HI
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