Provider Demographics
NPI:1013416817
Name:ORCHID ISLE DENTAL
Entity Type:Organization
Organization Name:ORCHID ISLE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-775-7594
Mailing Address - Street 1:45-3290 OHIA ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HONOKAA
Mailing Address - State:HI
Mailing Address - Zip Code:96727-6935
Mailing Address - Country:US
Mailing Address - Phone:808-775-7294
Mailing Address - Fax:808-775-1314
Practice Address - Street 1:45-3290 OHIA ST STE 1
Practice Address - Street 2:
Practice Address - City:HONOKAA
Practice Address - State:HI
Practice Address - Zip Code:96727-6935
Practice Address - Country:US
Practice Address - Phone:808-775-7294
Practice Address - Fax:808-775-1314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental