Provider Demographics
NPI:1952941817
Name:OAHU ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:OAHU ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING AND CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-230-8000
Mailing Address - Street 1:45-1144 KAMEHAMEHA HWY STE 301
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3226
Mailing Address - Country:US
Mailing Address - Phone:808-230-8000
Mailing Address - Fax:808-369-8292
Practice Address - Street 1:1441 KAPIOLANI BLVD STE 920
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4405
Practice Address - Country:US
Practice Address - Phone:808-973-3700
Practice Address - Fax:808-973-3707
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAHU ORAL & MAXILLOFACIAL SURGERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty