Provider Demographics
NPI:1275308264
Name:LINDSEY KAWAHAKUI
Entity Type:Organization
Organization Name:LINDSEY KAWAHAKUI
Other - Org Name:SOUTHERN COLORADO FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:GERLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS MORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-566-0206
Mailing Address - Street 1:2047 COLUMBIA DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3279
Mailing Address - Country:US
Mailing Address - Phone:719-566-0206
Mailing Address - Fax:719-561-1095
Practice Address - Street 1:2047 COLUMBIA DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-3279
Practice Address - Country:US
Practice Address - Phone:719-566-0206
Practice Address - Fax:719-561-1095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty