Provider Demographics
NPI:1568503258
Name:CHILDREN'S DENTAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CHILDREN'S DENTAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-680-0097
Mailing Address - Street 1:1314 S KING ST
Mailing Address - Street 2:SUITE 618
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1956
Mailing Address - Country:US
Mailing Address - Phone:808-596-9889
Mailing Address - Fax:808-596-9892
Practice Address - Street 1:94-673 KUPUOHI ST
Practice Address - Street 2:SUITE C103
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5367
Practice Address - Country:US
Practice Address - Phone:808-680-0097
Practice Address - Fax:808-680-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
206901OtherHDS
199801OtherHDS
HI54928002Medicare ID - Type Unspecified
HI54086602Medicare ID - Type Unspecified