Provider Demographics
NPI:1285865170
Name:SWEET TOOTH DENTAL INC.
Entity Type:Organization
Organization Name:SWEET TOOTH DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:BK
Authorized Official - Last Name:OKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-329-0889
Mailing Address - Street 1:75-5660 KOPIKO ST STE B2
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3121
Mailing Address - Country:US
Mailing Address - Phone:808-329-0889
Mailing Address - Fax:808-329-5062
Practice Address - Street 1:75-5660 KOPIKO ST STE B2
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3121
Practice Address - Country:US
Practice Address - Phone:808-329-0889
Practice Address - Fax:808-329-5062
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SWEET TOOTH DENTAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1987-01305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization