Provider Demographics
NPI:1043606270
Name:FREDRIC C GAETA DDS
Entity Type:Organization
Organization Name:FREDRIC C GAETA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:C
Authorized Official - Last Name:GAETA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-329-3314
Mailing Address - Street 1:75-5706 HANAMA PL
Mailing Address - Street 2:SUITE 105A
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1745
Mailing Address - Country:US
Mailing Address - Phone:808-329-3314
Mailing Address - Fax:808-329-1354
Practice Address - Street 1:75-5706 HANAMA PL
Practice Address - Street 2:SUITE 105A
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1745
Practice Address - Country:US
Practice Address - Phone:808-329-3314
Practice Address - Fax:808-329-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty