Provider Demographics
NPI:1356730535
Name:HAWAII DENTAL GROUP, INC
Entity type:Organization
Organization Name:HAWAII DENTAL GROUP, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERROL
Authorized Official - Middle Name:YW
Authorized Official - Last Name:YIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-222-4059
Mailing Address - Street 1:500 ALA MOARA BLVD.
Mailing Address - Street 2:SUITE 7-220
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813
Mailing Address - Country:US
Mailing Address - Phone:808-523-3103
Mailing Address - Fax:808-523-3122
Practice Address - Street 1:91-1121 KEAUNUI DR.
Practice Address - Street 2:BLDG M SPACE 6
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706
Practice Address - Country:US
Practice Address - Phone:808-675-5562
Practice Address - Fax:808-675-5563
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAWAII DENTAL GROUP, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty