# DEPT. OF HEALTH-HI DEVELOPMENTAL DISABILITIES H&CDSB (DENTAL)

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** STATE OF HAWAII, DEPARTMENT OF HEALTH
- **Other names:** HAWAII DPEARTMENT OF HEALTH
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1932675212
- **Legal business name:** STATE OF HAWAII, DEPARTMENT OF HEALTH
- **Authorized official:** MARY BROGAN (DDD ADMINISTRATOR)
- **Authorized official phone:** (808) 586-5842

## Contact information

- **Practice address:** 1700 LANAKILA AVE RM 203, HONOLULU, HI 96817-2115
- **Practice address phone:** (808) 832-5710
- **Practice address fax:** (808) 832-5722
- **Mailing address:** 1250 PUNCHBOWL ST STE 463, HONOLULU, HI 96813-2416
- **Mailing address phone:** (808) 586-5842
- **Mailing address fax:** (808) 586-5844

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223D0001X | Public Health Dentistry | — | NULL | Yes |
| 1223D0001X | Public Health Dentistry | — | — | Yes |
| 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