Provider Demographics
NPI:1033219597
Name:FAY, PETER H (DMD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:H
Last Name:FAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HOOHANA ST., #300
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732
Mailing Address - Country:US
Mailing Address - Phone:808-871-6283
Mailing Address - Fax:
Practice Address - Street 1:140 HOOHANA ST., #300
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732
Practice Address - Country:US
Practice Address - Phone:808-871-6283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI12871223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics