Provider Demographics
NPI:1063647931
Name:KONA CENTER OF FACIAL SURGERY
Entity Type:Organization
Organization Name:KONA CENTER OF FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRECO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-885-9000
Mailing Address - Street 1:65-1230 MAMALAHOA HWY
Mailing Address - Street 2:C10-12
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8318
Mailing Address - Country:US
Mailing Address - Phone:808-885-9000
Mailing Address - Fax:
Practice Address - Street 1:65-1230 MAMALAHOA HWY
Practice Address - Street 2:C10-12
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8318
Practice Address - Country:US
Practice Address - Phone:808-885-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT18131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03442901Medicaid
HI38042OtherHAWAII MEDICAL SERVICE ASSOCIATION
U52737Medicare UPIN