Provider Demographics
NPI:1265687776
Name:CAMBRA, JAY ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:ADAM
Last Name:CAMBRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 KILANI AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1904
Mailing Address - Country:US
Mailing Address - Phone:808-622-9344
Mailing Address - Fax:
Practice Address - Street 1:612 KILANI AVE FL 2
Practice Address - Street 2:
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1904
Practice Address - Country:US
Practice Address - Phone:808-622-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI14801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice