Provider Demographics
NPI:1023742905
Name:HAWAII PEDIATRIC DENTISTRY LLC
Entity type:Organization
Organization Name:HAWAII PEDIATRIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-753-9094
Mailing Address - Street 1:91-3575 KAULUAKOKO ST UNIT 3004
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-5857
Mailing Address - Country:US
Mailing Address - Phone:781-951-4055
Mailing Address - Fax:
Practice Address - Street 1:91-3575 KAULUAKOKO ST UNIT 3004
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-5857
Practice Address - Country:US
Practice Address - Phone:781-951-4055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-15
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty