Provider Demographics
NPI:1427578103
Name:AA WINDWARD DENTAL GROUP
Entity Type:Organization
Organization Name:AA WINDWARD DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:THAD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAWAKAMI-WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-247-4118
Mailing Address - Street 1:45-1144 KAM HWY STE 401
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3226
Mailing Address - Country:US
Mailing Address - Phone:808-247-4118
Mailing Address - Fax:
Practice Address - Street 1:45-1144 KAMEHAMEHA HWY STE 401
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3226
Practice Address - Country:US
Practice Address - Phone:808-247-4118
Practice Address - Fax:808-247-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty