Provider Demographics
NPI:1912632944
Name:BIG ISLAND ORAL SURGERY LLC
Entity Type:Organization
Organization Name:BIG ISLAND ORAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ISADORE
Authorized Official - Last Name:ROTWEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-822-7500
Mailing Address - Street 1:135 PUUHONU WAY
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2069
Mailing Address - Country:US
Mailing Address - Phone:732-822-7500
Mailing Address - Fax:
Practice Address - Street 1:135 PUUHONU WAY
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2069
Practice Address - Country:US
Practice Address - Phone:732-822-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty