| NPI | 1770044158 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARON R STEVENS COO And CFO 808-208-7796 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics |
| Additional Taxonomies | 1223G0001X Dentist General Practice |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2019-03-27 |