Provider Demographics
NPI:1598896987
Name:ALCANTRA, GENARA DABU (DMD)
Entity Type:Individual
Prefix:DR
First Name:GENARA
Middle Name:DABU
Last Name:ALCANTRA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 KAMOKILA BLVD STE 157
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2090
Mailing Address - Country:US
Mailing Address - Phone:808-692-8888
Mailing Address - Fax:808-692-8885
Practice Address - Street 1:1001 KAMOKILA BLVD STE 157
Practice Address - Street 2:
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2090
Practice Address - Country:US
Practice Address - Phone:808-692-8888
Practice Address - Fax:808-692-8885
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT22581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI990352654Medicaid