Provider Demographics
NPI:1528484334
Name:ALOHA STADIUM DENTAL ASSOCIATES
Entity type:Organization
Organization Name:ALOHA STADIUM DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-487-9948
Mailing Address - Street 1:4510 SALT LAKE BLVD
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96818-3153
Mailing Address - Country:US
Mailing Address - Phone:808-487-9948
Mailing Address - Fax:
Practice Address - Street 1:4510 SALT LAKE BLVD
Practice Address - Street 2:SUITE B-3
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96818-3153
Practice Address - Country:US
Practice Address - Phone:808-487-9948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALOHA STADIUM DENTAL ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-17
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI170400A00787491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty