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General NPI Number Information
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NPI Number | 1730588237
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Entity Type | Organization
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Legal Business Name | DENTAL IMPLANT ASSOCIATES, LLC
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Dates
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Enumeration Date | 08/20/2014
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 1441 KAPIOLANI BLVD STE 803
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City | HONOLULU
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State | HI
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Zip | 96814-4404
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Country | US
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Telephone | 808-599-0481
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Fax | 855-866-2178
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Provider Business Mailing Address
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Address Line | 1441 KAPIOLANI BLVD STE 803
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City | HONOLULU
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State | HI
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Zip | 96814-4404
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Country | US
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Telephone | 808-599-0481
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Fax | 855-866-2178
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Authorized Official
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Title or Position | OWNER
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Name | TERRY R NGUYEN
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Credential | DDS
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Telephone | 808-969-1839
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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 | DT 2213
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License Number State | HI
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