Provider Demographics
NPI:1164948642
Name:OAHU ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:OAHU ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:OAHU ORAL SURGRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-230-8000
Mailing Address - Street 1:45-1144 KAM HWY STE 301
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3226
Mailing Address - Country:US
Mailing Address - Phone:808-230-8000
Mailing Address - Fax:808-369-8292
Practice Address - Street 1:45-1144 KAM HWY STE 301
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3226
Practice Address - Country:US
Practice Address - Phone:808-230-8000
Practice Address - Fax:808-369-8292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2297261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery