Provider Demographics
NPI:1518342401
Name:WEST OAHU DENTAL CARE, INC.
Entity Type:Organization
Organization Name:WEST OAHU DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DE LOS REYES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-389-7568
Mailing Address - Street 1:95-207 KELAKELA PL
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-5990
Mailing Address - Country:US
Mailing Address - Phone:808-389-7568
Mailing Address - Fax:808-626-9977
Practice Address - Street 1:94-801 FARRINGTON HWY STE 208
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3149
Practice Address - Country:US
Practice Address - Phone:808-671-7272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-21
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-1855261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental