Enchanted Lake Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

ENCHANTED LAKE DENTAL LLC

Practice address

1058 Keolu Dr Ste B104
Kailua, HI 96734-3844

Phone

(808) 261-6767

NPI assigned

May 15, 2023

Last updated

May 15, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Justin Sjulson, DDSNPI 1881854701

Title

Owner

Phone

(952) 353-0411

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Justin D. Sjulson, DDS

  • Dentist
  • Tacoma, WA
  • NPI 1881854701
  NPD Authorized official
• Steven Satory Uchida, DDS

  • General Practice Dentistry
  • Kailua, HI
  • NPI 1336350610
  NPD (past)

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1588355267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1058 KEOLU DR STE B104",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967343844",
            "telephone_number": "808-261-6767"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1058 KEOLU DR STE B104",
            "city": "KAILUA",
            "state": "HI",
            "postal_code": "967343844",
            "telephone_number": "808-261-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENCHANTED LAKE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-15",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-15",
        "status": "A",
        "authorized_official_last_name": "SJULSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-353-0411",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Keolani Taitano, PH.D., LLC (Windward Behavioral Health)
• Richard Harris Ellsasser, M.D.
• Jason Mark Ellwood, DO
• Margaret Embick, LCSW, RDT
• Sherilynn Yae Emiliano, LMHC
• John Sterling Endicott, M.D., M.P.H.
• Endo Arte LLC
• Kim Endreson, LMT
• Enhance Hawaii LLC
• John Enrico

• Dentist in Kailua, HI
• Providers in Kailua, HI by specialty
• Dentist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; 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.