Provider Demographics
NPI:1396097259
Name:TINA N. TOM, DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:TINA N. TOM, DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINA
Authorized Official - Middle Name:N
Authorized Official - Last Name:TOM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-778-4929
Mailing Address - Street 1:1600 KAPIOLANI BLVD STE 807
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3802
Mailing Address - Country:US
Mailing Address - Phone:808-778-4929
Mailing Address - Fax:
Practice Address - Street 1:1600 KAPIOLANI BLVD STE 807
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-3802
Practice Address - Country:US
Practice Address - Phone:808-778-4929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TINA N. TOM, DDS A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT17041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty