Provider Demographics
NPI:1659416964
Name:TOM, PHILIP K B (DDS)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:K B
Last Name:TOM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 WAIALAE AVENUE
Mailing Address - Street 2:SUITE #376
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816
Mailing Address - Country:US
Mailing Address - Phone:808-737-9032
Mailing Address - Fax:808-737-0290
Practice Address - Street 1:3221 WAIALAE AVE
Practice Address - Street 2:SUITE #376
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5842
Practice Address - Country:US
Practice Address - Phone:808-737-9032
Practice Address - Fax:808-737-0290
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice