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General NPI Number Information
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NPI Number | 1578887030
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Entity Type | Organization
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Legal Business Name | THE TOOTH SURFER LLC
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Dates
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Enumeration Date | 03/26/2010
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Last Update Date | 03/26/2010
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Provider Practice Location Address
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Address Line | 3045 MONSARRAT AVE SUITE 7
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City | HONOLULU
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State | HI
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Zip | 96815-4400
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Country | US
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Telephone | 808-375-2745
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Fax | 808-732-0240
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Provider Business Mailing Address
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Address Line | 317 PUIWA ROAD
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City | HONOLULU
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State | HI
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Zip | 96817
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Country | US
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Telephone | 808-375-2745
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Fax | 925-743-1432
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Authorized Official
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Title or Position | MEMBER
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Name | DR. DARREN D.K. WONG
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Credential | D.D.S.
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Telephone | 808-375-2745
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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 | DT2033
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License Number State | HI
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