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General NPI Number Information
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NPI Number | 1457724940
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Entity Type | Organization
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Legal Business Name | 12TH AVENUE DENTAL CENTRE, LLC
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 1144 12TH AVE
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City | HONOLULU
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State | HI
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Zip | 96816-3712
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Country | US
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Telephone | 808-737-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 1144 12TH AVE
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City | HONOLULU
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State | HI
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Zip | 96816-3712
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Country | US
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Telephone | 808-737-3311
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | DR. PATRICK HAYASHI
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Credential | D.D.S.
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Telephone | 808-737-3311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 1514
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License Number State | HI
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