| Enchanted Lake Dental Llc | |
|
1058 Keolu Dr Ste B104 Kailua HI 96734-3844 | |
| (808) 261-6767 | |
| Not Available |
| Full Name | Enchanted Lake Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 1058 Keolu Dr Ste B104, Kailua, Hawaii |
| Authorized Official Name and Position | Justin Sjulson (OWNER) |
| Authorized Official Contact | 9523530411 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Enchanted Lake Dental Llc 1058 Keolu Dr Ste B104 Kailua HI 96734-3844 Ph: (808) 261-6767 | Enchanted Lake Dental Llc 1058 Keolu Dr Ste B104 Kailua HI 96734-3844 Ph: (808) 261-6767 |
| NPI Number | 1588355267 |
|---|---|
| Provider Enumeration Date | 05/15/2023 |
| Last Update Date | 05/15/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588355267 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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