Provider Demographics
NPI:1952350027
Name:CARRENO, ILEANA (DDS)
Entity Type:Individual
Prefix:MS
First Name:ILEANA
Middle Name:
Last Name:CARRENO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:95754
Mailing Address - Country:US
Mailing Address - Phone:808-828-6675
Mailing Address - Fax:808-828-1774
Practice Address - Street 1:2484 KOLO RD
Practice Address - Street 2:
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:95754
Practice Address - Country:US
Practice Address - Phone:808-828-1863
Practice Address - Fax:808-828-1774
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist