NPIMap

Organization Active NPI

Pacific Family Dental, Inc.

  • Dental Clinic/Center
  • Honolulu, HI
National Provider Identifier
1033328646
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
DT1923 Issued in HI
Legal business name
PACIFIC FAMILY DENTAL, INC.
Practice address
4429 Malaai St
Suite 103
Honolulu, HI 96818-3158
Phone
(808) 422-1155
NPI assigned
May 21, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark Kekoa Watanabe, DDSNPI 1093924698
Title
President
Phone
(808) 422-1155

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X DT1923 HI Primary

Addresses

Primary practice location

4429 Malaai St
Suite 103
Honolulu, HI 96818-3158

Mailing address

4429 Malaai St
Suite 103
Honolulu, HI 96818-3158
Phone (808) 422-1155

National Provider Directory

National Provider Directory

Locations

4429 Malaai St
Ste 103
Honolulu, HI 96818
Phone (808) 422-1155

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033328646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4429 MALAAI ST",
            "address_2": "SUITE 103",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968183158",
            "telephone_number": "808-422-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4429 MALAAI ST",
            "address_2": "SUITE 103",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968183158",
            "telephone_number": "808-422-1155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC FAMILY DENTAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WATANABE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "KEKOA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "808-422-1155",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "HI",
            "license": "DT1923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.