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Organization
DEPT. OF HEALTH-HI DEVELOPMENTAL DISABILITIES H&CDSB (DENTAL)
Active
Organization
DEPT. OF HEALTH-HI DEVELOPMENTAL DISABILITIES H&CDSB (DENTAL)
Active
Parent organization
STATE OF HAWAII, DEPARTMENT OF HEALTH
Other names
HAWAII DPEARTMENT OF HEALTH
Organization subpart
Yes
Provider details
NPI number
Legal business name
STATE OF HAWAII, DEPARTMENT OF HEALTH
Authorized official
MARY BROGAN (DDD ADMINISTRATOR)
(808) 586-5842
Entity
Organization
Contact information
Practice address
1700 LANAKILA AVE RM 203, HONOLULU, HI 96817-2115
(808) 832-5710
(808) 832-5722
Mailing address
1250 PUNCHBOWL ST STE 463, HONOLULU, HI 96813-2416
(808) 586-5842
(808) 586-5844
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
—
NULL
1223D0001X
Public Health Dentistry
Primary
—
—
124Q00000X
Dental Hygienist
—
NULL
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
NULL
126800000X
Dental Assistant
—
—
Other
Enumeration date
10/15/2018
Last updated
10/15/2018
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