Provider Demographics
NPI:1356686844
Name:DENTAL CONCEPTS LLC
Entity Type:Organization
Organization Name:DENTAL CONCEPTS LLC
Other - Org Name:PEARL CITY DENTAL CORNER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:DK
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:925-956-2002
Mailing Address - Street 1:98-1238 KAAHUMANU ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-3291
Mailing Address - Country:US
Mailing Address - Phone:808-487-3355
Mailing Address - Fax:808-486-3535
Practice Address - Street 1:98-1238 KAAHUMANU ST
Practice Address - Street 2:SUITE 305
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-3291
Practice Address - Country:US
Practice Address - Phone:808-487-3355
Practice Address - Fax:808-486-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI20331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty