Provider Demographics
NPI:1043744170
Name:SMILES FOR KEIKI PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:SMILES FOR KEIKI PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:NAVARRO
Authorized Official - Last Name:RAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-543-7439
Mailing Address - Street 1:4211 WAIALAE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5312
Mailing Address - Country:US
Mailing Address - Phone:808-737-0076
Mailing Address - Fax:
Practice Address - Street 1:4211 WAIALAE AVE STE 201
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5312
Practice Address - Country:US
Practice Address - Phone:808-737-0076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-15
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-26461223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty