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General NPI Number Information
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NPI Number | 1790121739
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Entity Type | Organization
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Legal Business Name | SALT LAKE FAMILY DENTISTRY
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 848 ALA LILIKOI ST STE 112
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City | HONOLULU
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State | HI
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Zip | 96818-2109
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Country | US
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Telephone | 808-839-7209
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Fax | 808-836-7700
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Provider Business Mailing Address
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Address Line | 848 ALA LILIKOI ST STE 112
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City | HONOLULU
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State | HI
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Zip | 96818-2109
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Country | US
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Telephone | 808-839-7209
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Fax | 808-836-7700
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Authorized Official
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Title or Position | OWNER
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Name | CHERYL TAMANAHA
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Credential |
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Telephone | 808-839-7209
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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 | DT1944
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License Number State | HI
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