Provider Demographics
NPI:1376616557
Name:DOSSANTOS, BRIAN JOSEPH (LAC, LMT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JOSEPH
Last Name:DOSSANTOS
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:94-510 LUMIAINA ST
Mailing Address - Street 2:# T-103
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5290
Mailing Address - Country:US
Mailing Address - Phone:808-387-4678
Mailing Address - Fax:808-455-4442
Practice Address - Street 1:803 KAM HWY
Practice Address - Street 2:# 416
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2680
Practice Address - Country:US
Practice Address - Phone:808-387-4678
Practice Address - Fax:808-455-4442
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HI769171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist