Provider Demographics
NPI:1932473634
Name:HAWAII DENTAL WELLNESS, LLC
Entity Type:Organization
Organization Name:HAWAII DENTAL WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDAL
Authorized Official - Middle Name:T
Authorized Official - Last Name:MOTOOKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-533-3892
Mailing Address - Street 1:1139 BETHEL ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2207
Mailing Address - Country:US
Mailing Address - Phone:808-533-3892
Mailing Address - Fax:808-523-1240
Practice Address - Street 1:1139 BETHEL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2207
Practice Address - Country:US
Practice Address - Phone:808-533-3892
Practice Address - Fax:808-523-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI17841223G0001X
HI19611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty