Provider Demographics
NPI:1285934554
Name:WEST OAHU DENTAL CENTER LLC
Entity type:Organization
Organization Name:WEST OAHU DENTAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GENARA
Authorized Official - Middle Name:DABU
Authorized Official - Last Name:ALCANTRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-692-8888
Mailing Address - Street 1:1001 KAMOKILA BLVD
Mailing Address - Street 2:SUITE 157
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707-2014
Mailing Address - Country:US
Mailing Address - Phone:808-692-8888
Mailing Address - Fax:808-692-8884
Practice Address - Street 1:1001 KAMOKILA BLVD
Practice Address - Street 2:SUITE 157
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707-2014
Practice Address - Country:US
Practice Address - Phone:808-692-8888
Practice Address - Fax:808-692-8884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT22581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI58619102Medicaid