| NPI | 1013433341 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADFORD MATIASEVICH Owner/Dentist 808-366-1097 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental (Licence: HI 2481) |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2018-06-16 |