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General NPI Number Information
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NPI Number | 1932288008
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Entity Type | Organization
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Legal Business Name | WAHIAWA FAMILY DENTAL CARE, LLP
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 302 CALIFORNIA AVE STE 204
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City | WAHIAWA
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State | HI
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Zip | 96786-1841
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Country | US
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Telephone | 808-622-2633
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Fax | 808-622-2342
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Provider Business Mailing Address
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Address Line | 302 CALIFORNIA AVE STE 204
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City | WAHIAWA
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State | HI
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Zip | 96786-1841
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | LARA SATO
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Credential |
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Telephone | 808-622-2633
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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-1137
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License Number State | HI
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