Provider Demographics
NPI:1962617597
Name:ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES INC
Entity type:Organization
Organization Name:ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-973-3747
Mailing Address - Street 1:1580 MAKALOA ST
Mailing Address - Street 2:SUITE 725
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-3237
Mailing Address - Country:US
Mailing Address - Phone:808-973-3747
Mailing Address - Fax:808-973-3757
Practice Address - Street 1:1580 MAKALOA ST
Practice Address - Street 2:SUITE 725
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814
Practice Address - Country:US
Practice Address - Phone:808-973-3747
Practice Address - Fax:808-973-3757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI10881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1326130717OtherINDIVIDUAL NPI
HI1689772659OtherPATNER'S INDIVIDUAL NPI
HIHOMSOtherMEDICARE LEGACY