Provider Demographics
NPI:1861067480
Name:HONOLULU DENTAL CARE, LLC
Entity type:Organization
Organization Name:HONOLULU DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CEDRIC
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-349-3165
Mailing Address - Street 1:72 MOANIALA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2544
Mailing Address - Country:US
Mailing Address - Phone:808-428-3278
Mailing Address - Fax:
Practice Address - Street 1:1441 KAPIOLANI BLVD STE 1207
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4406
Practice Address - Country:US
Practice Address - Phone:808-354-0440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental