Provider Demographics
NPI:1588691554
Name:PERRINO, JOSEPH MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:PERRINO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JOSEPH
Other - Middle Name:MICHAEL
Other - Last Name:PERRINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:85-910 FARRINGTON HWY
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792
Mailing Address - Country:US
Mailing Address - Phone:808-696-7031
Mailing Address - Fax:808-696-3010
Practice Address - Street 1:85-910 FARRINGTON HWY
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792
Practice Address - Country:US
Practice Address - Phone:808-696-7031
Practice Address - Fax:808-696-3010
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI01943601Medicaid