Organization
HAWAI I MOBILE DENTAL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADLEY THOMAS-TERROLL HAWKINS DDS (GENERAL DENTIST/PRESIDENT)
(808) 201-9273
Entity
Organization
Contact information
Practice address
95-390 KUAHELANI AVE, 3AC-1193, MILILANI, HI 96789-1192
(808) 201-9273
Mailing address
95-390 KUAHELANI AVE # 3AC-1193, MILILANI, HI 96789-1192
(808) 201-9273
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15743316
ADA CREDENTIALLING PORTAL: CAQH
HI
Enumeration date
10/20/2022
Last updated
01/18/2023
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