Provider Demographics
NPI:1164750246
Name:12TH AVENUE DENTAL CENTRE LLC
Entity Type:Organization
Organization Name:12TH AVENUE DENTAL CENTRE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-737-3311
Mailing Address - Street 1:1144 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3712
Mailing Address - Country:US
Mailing Address - Phone:808-737-3311
Mailing Address - Fax:808-737-3331
Practice Address - Street 1:1144 12TH AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3712
Practice Address - Country:US
Practice Address - Phone:808-737-3311
Practice Address - Fax:808-737-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty