Provider Demographics
NPI:1770667131
Name:TOM, DEREK B (DDS)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name: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 1:98-150 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI20081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry