Provider Demographics
NPI:1609256098
Name:LYLE T. TENJOMA DDS, MSD
Entity Type:Organization
Organization Name:LYLE T. TENJOMA DDS, MSD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYLE
Authorized Official - Middle Name:T
Authorized Official - Last Name:TENJOMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:808-927-5159
Mailing Address - Street 1:1441 KAPIOLANI BLVD STE 1120
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4406
Mailing Address - Country:US
Mailing Address - Phone:808-927-5159
Mailing Address - Fax:808-949-0115
Practice Address - Street 1:1441 KAPIOLANI BLVD STE 1120
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4406
Practice Address - Country:US
Practice Address - Phone:808-927-5159
Practice Address - Fax:808-949-0115
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LYLE T. TENJOMA DDS, MSD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-01
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1262122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty