Provider Demographics
NPI:1538641337
Name:DUMBRIQUE DENTAL CLINIC
Entity Type:Organization
Organization Name:DUMBRIQUE DENTAL CLINIC
Other - Org Name:DUMBRIQUE DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CELIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DUMBRIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-676-2435
Mailing Address - Street 1:94-366 PUPUPANI ST STE 205
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2644
Mailing Address - Country:US
Mailing Address - Phone:808-676-2435
Mailing Address - Fax:808-671-4568
Practice Address - Street 1:94-366 PUPUPANI ST STE 205
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2644
Practice Address - Country:US
Practice Address - Phone:808-676-2435
Practice Address - Fax:808-671-4568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1710920574Medicaid