Provider Demographics
NPI:1609200435
Name:UPERESA, BROOKE MAILE BURGESS (DDS)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:MAILE BURGESS
Last Name:UPERESA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 WAIALAE AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-3257
Mailing Address - Country:US
Mailing Address - Phone:808-737-3525
Mailing Address - Fax:808-737-1964
Practice Address - Street 1:3660 WAIALAE AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-3257
Practice Address - Country:US
Practice Address - Phone:808-737-3525
Practice Address - Fax:808-737-1964
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist