=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801133871
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUNSHINE DENTAL CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2013
-----------------------------------------------------
Last Update Date | 01/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 94-748 D HIKIMOE STREET
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-3350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-677-3751
-----------------------------------------------------
Fax | 808-677-8646
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 94-748 D HIKIMOE STREET
-----------------------------------------------------
City | WAIPAHU
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96797-3350
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-677-3751
-----------------------------------------------------
Fax | 808-677-8646
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ELAINE ALFARO MESINAS
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 808-677-3751
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | DT-1869
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------