Organization
HAWAIIAN ISLAND DENTAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL P JAUREQUI DDS (OWNER)
(808) 245-8866
Entity
Organization
Contact information
Practice address
4370 KUKUI GROVE ST, SUITE 211, LIHUE, HI 96766-2001
(808) 245-8866
(808) 246-0698
Mailing address
4370 KUKUI GROVE ST, SUITE 211, LIHUE, HI 96766-2001
(808) 245-8866
(808) 246-0698
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
HI2009
HI
Other
Enumeration date
01/20/2010
Last updated
08/01/2014
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