MEDICARE: HAWAII DENTAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223P0300X	Periodontics
3	1223P0700X	Prosthodontics
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
5	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
6	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1205992922
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAWAII DENTAL GROUP, INC.

Provider Business Mailing Address
First Line	:	500 ALA MOANA BLVD
Second Line	:	SUITE 7-220
City	:	HONOLULU
State	:	HI
Zip	:	96813-4920
Country	:	US
Telephone Number	:	808-523-3103
Fax Number	:	808-523-3122

Provider Business Practice Location Address
First Line	:	500 ALA MOANA BLVD
Second Line	:	SUITE 7-220
City	:	HONOLULU
State	:	HI
Zip	:	96813-4920
Country	:	US
Telephone Number	:	808-523-3103
Fax Number	:	808-523-3122

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERROL Y.W. YIM
Credential	:
Telephone Number	:	808-523-3103

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	10/14/2014

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Directions to “HAWAII DENTAL GROUP, INC. ” Practice Location

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