Provider Demographics
NPI:1619689510
Name:SHIMABUKURO DENTAL LLC
Entity Type:Organization
Organization Name:SHIMABUKURO DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEA
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:SHIMABUKURO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-332-7088
Mailing Address - Street 1:PO BOX 427
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-0427
Mailing Address - Country:US
Mailing Address - Phone:808-332-7088
Mailing Address - Fax:
Practice Address - Street 1:2-2389 KAUMUALII HIGHWAY
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741
Practice Address - Country:US
Practice Address - Phone:808-332-7088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-22
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental