Pacific Rim Dental Group, LLC

Key facts

NPI

1184089765

Entity type

Organization (NPI type 2)

Primary specialty

General Practice Dentistry 1223G0001X

License

1632 (HI)

Legal business name

PACIFIC RIM DENTAL GROUP, LLC

Practice address

4366 Kukui Grove St
204
Lihue, HI 96766-2006

Phone

(808) 378-4754

Fax

(808) 748-0389

NPI assigned

Dec 23, 2015

Organization subpart

No

Authorized official

Name

Terry Robert Allen, DDS NPI 1407909401

Title

Dentist/Owner

Phone

(808) 378-4754

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

Practitioners 1

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

• Terry Robert Allen, DDS General Practice Dentistry · Lihue, HI · NPI 1407909401
  NPD (past) Authorized official GENERAL PRACTICE

National Provider Directory

Locations

Specialties & licenses

Addresses

Other names

• Lihue Dental Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 23, 2015.

{
    "created_epoch": "1450828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1450828800000",
    "number": "1184089765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4366 KUKUI GROVE ST",
            "address_2": "204",
            "city": "LIHUE",
            "state": "HI",
            "postal_code": "967662006",
            "telephone_number": "808-378-4754",
            "fax_number": "808-748-0389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4366 KUKUI GROVE ST",
            "address_2": "204",
            "city": "LIHUE",
            "state": "HI",
            "postal_code": "967662006",
            "telephone_number": "808-378-4754",
            "fax_number": "808-748-0389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC RIM DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-23",
        "last_updated": "2015-12-23",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "808-378-4754",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "HI",
            "license": "1632",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lihue Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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All providers in Lihue, HI · General Practice Dentistry in Hawaii