| NPI | 1952941817 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEIDI MARTIN Credentialing And Contracting 808-230-8000 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2020-01-08 |