=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386050508
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTURY DENTAL, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2014
-----------------------------------------------------
Last Update Date | 07/08/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1188 BISHOP ST STE 3508
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-3314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-387-9525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1188 BISHOP ST STE 3508
-----------------------------------------------------
City | HONOLULU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96813-3314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. WILLIAM LI
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 808-387-9525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DT2430
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------