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General NPI Number Information
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NPI Number | 1962617597
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Entity Type | Organization
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Legal Business Name | ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES INC
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 09/04/2018
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Provider Practice Location Address
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Address Line | 1580 MAKALOA ST SUITE 725
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City | HONOLULU
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State | HI
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Zip | 96814
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Country | US
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Telephone | 808-973-3747
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Fax | 808-973-3757
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Provider Business Mailing Address
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Address Line | 1580 MAKALOA ST SUITE 725
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City | HONOLULU
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State | HI
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Zip | 96814-3237
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Country | US
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Telephone | 808-973-3747
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Fax | 808-973-3757
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY LUNG
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Credential | D.M.D.
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Telephone | 808-973-3747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 1088
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License Number State | HI
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