Active NPI
Ethan Thomas Segerstrom, DDS
- General Practice Dentistry
- Jbphh, HI
National Provider Identifier
1649162017
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DDS-10368
- Practice address
- 480 Central Ave BLDG 1750
Jbphh, HI 96860-4908 - Phone
- (888) 683-2778
- NPI assigned
- Jul 18, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DDS-10368 | IA | Primary |
Addresses
Primary practice location
480 Central Ave BLDG 1750
Jbphh, HI 96860-4908
Mailing address
480 Central Ave
Pearl Harbor, HI 96860-4908
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DDS-10368 | IA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1752796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785974400000",
"number": "1649162017",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "480 CENTRAL AVE",
"city": "PEARL HARBOR",
"state": "HI",
"postal_code": "968604908"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "480 CENTRAL AVE BLDG 1750",
"city": "JBPHH",
"state": "HI",
"postal_code": "968604908",
"telephone_number": "888-683-2778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEGERSTROM",
"first_name": "ETHAN",
"middle_name": "THOMAS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-07-18",
"last_updated": "2026-08-06",
"certification_date": "2026-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IA",
"license": "DDS-10368",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jbphh, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.