Provider Demographics
NPI:1427473214
Name:SUNSHINE DENTAL CENTER, LLC
Entity type:Organization
Organization Name:SUNSHINE DENTAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:ALFARO
Authorized Official - Last Name:MESINAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-847-4868
Mailing Address - Street 1:1437 N KING ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4226
Mailing Address - Country:US
Mailing Address - Phone:808-847-4868
Mailing Address - Fax:808-841-9708
Practice Address - Street 1:1437 N KING ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4226
Practice Address - Country:US
Practice Address - Phone:808-847-4868
Practice Address - Fax:808-841-9708
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUNSHINE DENTAL CENTER,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-1869122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI07669101Medicaid