Provider Demographics
NPI:1487000329
Name:WAIPIO DENTISTS LLC
Entity Type:Organization
Organization Name:WAIPIO DENTISTS LLC
Other - Org Name:HAWAII DENTAL CLINIC - WAIPIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:WH
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-538-6522
Mailing Address - Street 1:50 S BERETANIA ST STE C117B
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2287
Mailing Address - Country:US
Mailing Address - Phone:808-538-6522
Mailing Address - Fax:
Practice Address - Street 1:50 S BERETANIA ST STE C117B
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2287
Practice Address - Country:US
Practice Address - Phone:808-538-6522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2521122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty