Provider Demographics
NPI:1487423604
Name:SERENKO, MADILYN GRACE (RDH)
Entity type:Individual
Prefix:
First Name:MADILYN
Middle Name:GRACE
Last Name:SERENKO
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 TUSITALA ST APT 1506
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-3127
Mailing Address - Country:US
Mailing Address - Phone:808-683-8133
Mailing Address - Fax:
Practice Address - Street 1:1329 LUSITANA ST STE 405
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2412
Practice Address - Country:US
Practice Address - Phone:808-526-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2300124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist