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General NPI Number Information
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NPI Number | 1558698381
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Entity Type | Organization
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Legal Business Name | BIG ISLE SMILE INC.
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Dates
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Enumeration Date | 11/16/2009
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 100 PAUAHI ST STE 210
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City | HILO
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State | HI
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Zip | 96720-3046
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Country | US
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Telephone | 808-935-5414
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Fax | 808-635-6010
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Provider Business Mailing Address
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Address Line | 100 PAUAHI ST STE 210
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City | HILO
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State | HI
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Zip | 96720-3046
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Country | US
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Telephone | 808-935-5414
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Fax | 808-635-6010
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GUY R RAPOZA
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Credential | DDS
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Telephone | 808-935-5414
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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 | DT 1752
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License Number State | HI
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