| NPI | 1194054940 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONRAD C THEISS Periodontist 808-877-3605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: GU DT0971) |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2009-12-08 |