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General NPI Number Information
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NPI Number | 1972823318
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Entity Type | Organization
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Legal Business Name | MARCOS S. CORPUZ, DDS, INC.
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 06/08/2010
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Provider Practice Location Address
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Address Line | 94-239 WAIPAHU DEPOT ST SUITE 212
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City | WAIPAHU
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State | HI
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Zip | 96797-3056
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Country | US
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Telephone | 808-671-4958
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Fax | 808-678-0191
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Provider Business Mailing Address
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Address Line | 94-239 WAIPAHU DEPOT ST SUITE 212
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City | WAIPAHU
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State | HI
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Zip | 96797-3056
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Country | US
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Telephone | 808-671-4958
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Fax | 808-678-0191
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARCOS S. CORPUZ
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Credential | DDS
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Telephone | 808-671-4958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DT1466
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License Number State | HI
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