Enchanted Lake Dental LLC

NPI #1588355267 in Kailua, Hawaii

Provider Information

NPI Number: 1588355267
Entity Type: Organization
Organization Name: Enchanted Lake Dental LLC
Primary Specialty: Dentist
Enumeration Date: May 15, 2023
Last Updated: May 15, 2023

Practice Location

Address: 1058 KEOLU DR STE B104
City: Kailua
State: Hawaii
ZIP Code: 96734-3844
Phone: (808) 261-6767

Authorized Official

Name: DR. JUSTIN SJULSON, DDS
Title: OWNER
Phone: (952) 353-0411

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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