Provider Demographics
NPI:1891895124
Name:TOM, BETTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BETTINA
Middle Name:
Last Name:TOM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:TOM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1600 KAPIOLANI BLVD.
Mailing Address - Street 2:SUITE 807
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814
Mailing Address - Country:US
Mailing Address - Phone:808-949-0033
Mailing Address - Fax:808-943-4316
Practice Address - Street 1:1600 KAPIOLANI BLVD.
Practice Address - Street 2:SUITE 807
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-949-0033
Practice Address - Fax:808-943-4316
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT17041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice