Provider Demographics
NPI:1275964868
Name:KYLE S.Q. CHOCK, D.M.D., INC.
Entity Type:Organization
Organization Name:KYLE S.Q. CHOCK, D.M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:LIANA
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:BOYCE-CABATU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-961-2878
Mailing Address - Street 1:212 ULULANI ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2629
Mailing Address - Country:US
Mailing Address - Phone:808-961-2878
Mailing Address - Fax:808-933-1651
Practice Address - Street 1:212 ULULANI ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-2629
Practice Address - Country:US
Practice Address - Phone:808-961-2878
Practice Address - Fax:808-933-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty