Provider Demographics
NPI:1689769879
Name:RAINBOW DENTAL CENTER KAPOLEI INC
Entity Type:Organization
Organization Name:RAINBOW DENTAL CENTER KAPOLEI INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INC PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERRYVEL
Authorized Official - Middle Name:MONTENEGRO
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-674-9090
Mailing Address - Street 1:599 FARRINGTON HIGHWAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707
Mailing Address - Country:US
Mailing Address - Phone:808-674-9090
Mailing Address - Fax:808-674-8399
Practice Address - Street 1:599 FARRINGTON HIGHWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707
Practice Address - Country:US
Practice Address - Phone:808-674-9090
Practice Address - Fax:808-674-8399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT1917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI191703OtherHDS
HI967539OtherUNITED CONCORDIA
HI=========OtherHMAA
HI=========OtherHMAA