Basic Information
Provider Information | |||||||||
NPI: | 1336128701 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TOTH | ||||||||
FirstName: | CHESTINE | ||||||||
MiddleName: | GUEVARRA | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DMD, MS | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GUEVARRA | ||||||||
OtherFirstName: | CHESTINE | ||||||||
OtherMiddleName: | SANDOVAL | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | DMD, MS | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | USA DENTAC | ||||||||
Address2: | BLDG 320 1 JARRETT WHITE ROAD, KRUKOWSKI ST | ||||||||
City: | TRIPLER AMC | ||||||||
State: | HI | ||||||||
PostalCode: | 968595000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8084331021 | ||||||||
FaxNumber: | 8084333928 | ||||||||
Practice Location | |||||||||
Address1: | USA DENTAC | ||||||||
Address2: | BLDG 320 1 JARRETT WHITE ROAD, KRUKOWSKI ST | ||||||||
City: | TRIPLER AMC | ||||||||
State: | HI | ||||||||
PostalCode: | 968595000 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8084331021 | ||||||||
FaxNumber: | 8084333928 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/12/2006 | ||||||||
LastUpdateDate: | 01/13/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DT-2133 | HI | N |   | Dental Providers | Dentist | General Practice | 1223P0300X | DT-2133 | HI | Y |   | Dental Providers | Dentist | Periodontics |
No ID Information.