Provider Demographics
NPI:1013334028
Name:SWEETWATER DENTAL L.L.C.
Entity Type:Organization
Organization Name:SWEETWATER DENTAL L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:XIAO LI
Authorized Official - Middle Name:SHELLY
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-947-2929
Mailing Address - Street 1:1136 UNION MALL SUITE 502
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-947-2929
Mailing Address - Fax:
Practice Address - Street 1:1136 UNION MALL SUITE 502
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-947-2929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2118122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI57533405Medicaid