Provider Demographics
NPI:1588770697
Name:DENTAL FITNESS INC
Entity type:Organization
Organization Name:DENTAL FITNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:CABUGON
Authorized Official - Last Name:OAMIL-PACHO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-677-5588
Mailing Address - Street 1:94-673 KUPUOHI STREET
Mailing Address - Street 2:SUITE C101
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1124
Mailing Address - Country:US
Mailing Address - Phone:808-677-5588
Mailing Address - Fax:808-677-6588
Practice Address - Street 1:94-673 KUPUOHI STREET
Practice Address - Street 2:SUITE C101
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1124
Practice Address - Country:US
Practice Address - Phone:808-677-5588
Practice Address - Fax:808-677-6588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DT1948OtherHMAA
1948OtherHDS
7861159OtherAETNA
183094OtherANTHEM
977589OtherUNITED CONCORDIA
1948OtherHDS
=========OtherCIGNA