Provider Demographics
NPI:1235387499
Name:SAN DIEGO, MAEMERITA B (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAEMERITA
Middle Name:B
Last Name:SAN DIEGO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MA EMERITA
Other - Middle Name:B
Other - Last Name:SAN DIEGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:2024 N KING ST STE 101A
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-3470
Mailing Address - Country:US
Mailing Address - Phone:808-597-8057
Mailing Address - Fax:
Practice Address - Street 1:2024 N KING ST STE 101A
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-3470
Practice Address - Country:US
Practice Address - Phone:808-597-8057
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-23351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice