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General NPI Number Information
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NPI Number | 1396097259
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Entity Type | Organization
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Legal Business Name | TINA N. TOM, DDS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 1600 KAPIOLANI BLVD STE 807
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City | HONOLULU
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State | HI
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Zip | 96814-3802
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Country | US
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Telephone | 808-778-4929
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Fax |
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Provider Business Mailing Address
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Address Line | 1600 KAPIOLANI BLVD STE 807
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City | HONOLULU
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State | HI
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Zip | 96814-3802
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Country | US
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Telephone | 808-778-4929
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | TINA N TOM
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Credential | DDS
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Telephone | 808-778-4929
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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 | DT1704
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License Number State | HI
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