Provider Demographics
NPI:1629212675
Name:AIEA PEDIATRIC DENTAL CENTER
Entity Type:Organization
Organization Name:AIEA PEDIATRIC DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:DAYNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-488-0100
Mailing Address - Street 1:98-150 KAONOHI ST
Mailing Address - Street 2:SUITE C-207
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5047
Mailing Address - Country:US
Mailing Address - Phone:808-488-0100
Mailing Address - Fax:808-488-0110
Practice Address - Street 1:98-150 KAONOHI ST
Practice Address - Street 2:SUITE C-207
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5047
Practice Address - Country:US
Practice Address - Phone:808-488-0100
Practice Address - Fax:808-488-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI20081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty