Provider Demographics
NPI:1346570330
Name:PERIOCARE
Entity Type:Organization
Organization Name:PERIOCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEAMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-263-1100
Mailing Address - Street 1:30 AULIKE ST STE 501
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-2752
Mailing Address - Country:US
Mailing Address - Phone:808-263-1100
Mailing Address - Fax:808-263-0111
Practice Address - Street 1:30 AULIKE ST STE 501
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2752
Practice Address - Country:US
Practice Address - Phone:808-263-1100
Practice Address - Fax:808-263-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI18591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty