Individual
MAVIS KEIKO GUSHIKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
21ST DENTAL MCBH, UNITE 38450, KANEOHE BAY, HI 96863
(808) 257-3100
Mailing address
PO BOX 63037, 21ST DENTAL MCBH, KANEOHE BAY, HI 96863
(808) 257-3100
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH-423
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H00766377
DRIVERS LICENSE
—
Enumeration date
08/03/2012
Last updated
08/03/2012
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