Provider Demographics
NPI:1467761775
Name:PERFECT SMILE DENTAL CENTER
Entity Type:Organization
Organization Name:PERFECT SMILE DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARICRIS
Authorized Official - Middle Name:HERNANDEZ
Authorized Official - Last Name:MACAPAGAL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-596-4434
Mailing Address - Street 1:615 PIIKOI ST
Mailing Address - Street 2:SUITE 1806
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3116
Mailing Address - Country:US
Mailing Address - Phone:808-596-4434
Mailing Address - Fax:808-597-1619
Practice Address - Street 1:615 PIIKOI ST
Practice Address - Street 2:SUITE 1806
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3116
Practice Address - Country:US
Practice Address - Phone:808-596-4434
Practice Address - Fax:808-597-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT20021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty