Provider Demographics
NPI:1285978296
Name:PUNAHOU DENTAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:PUNAHOU DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:WESSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-223-2731
Mailing Address - Street 1:900 PUNAHOU ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2500
Mailing Address - Country:US
Mailing Address - Phone:808-947-1323
Mailing Address - Fax:808-947-8902
Practice Address - Street 1:900 PUNAHOU ST STE 201
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-2500
Practice Address - Country:US
Practice Address - Phone:808-947-1323
Practice Address - Fax:808-947-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1309122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty