Provider Demographics
NPI:1245870526
Name:VAILLANCOURT, OUIDA SEARAY (RDH)
Entity type:Individual
Prefix:
First Name:OUIDA
Middle Name:SEARAY
Last Name:VAILLANCOURT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:OUIDA
Other - Middle Name:SEARAY
Other - Last Name:VAILLANCOURT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:92-100 WAIPAHE PL SLIP B-10
Mailing Address - Street 2:
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-4293
Mailing Address - Country:US
Mailing Address - Phone:585-678-5248
Mailing Address - Fax:
Practice Address - Street 1:339 MONGOMERY AVE
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:808-438-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020870-1124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist