Provider Demographics
NPI:1073928305
Name:BIG KAHUNA DENTAL, LLC DBA ALOHA DENTAL
Entity Type:Organization
Organization Name:BIG KAHUNA DENTAL, LLC DBA ALOHA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KASE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-969-9669
Mailing Address - Street 1:2792 S 5600 W
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-5590
Mailing Address - Country:US
Mailing Address - Phone:801-969-9669
Mailing Address - Fax:801-969-9779
Practice Address - Street 1:2792 S 5600 W
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-5590
Practice Address - Country:US
Practice Address - Phone:801-969-9669
Practice Address - Fax:801-969-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5672733-99221223G0001X
UT8919236-99211223G0001X
UT7579613-99231223P0221X
UT9474332-99221223P0221X
UT135181-99241223S0112X
UT317724-89031223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty