Provider Demographics
NPI:1598075517
Name:PERFECT SMILES DENTAL CENTER
Entity Type:Organization
Organization Name:PERFECT SMILES 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:808-841-5515
Mailing Address - Street 1:2153 N KING ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96819-4570
Mailing Address - Country:US
Mailing Address - Phone:808-841-5515
Mailing Address - Fax:808-848-1588
Practice Address - Street 1:2153 N KING ST
Practice Address - Street 2:SUITE 102
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819-4570
Practice Address - Country:US
Practice Address - Phone:808-841-5515
Practice Address - Fax:808-848-1588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERFECT SMILES DENTAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT20021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty