Provider Demographics
NPI:1508531104
Name:OBANA, KEVIN HOFILENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:HOFILENA
Last Name:OBANA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 HUNTERS RUN DR
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-6322
Mailing Address - Country:US
Mailing Address - Phone:313-338-8255
Mailing Address - Fax:
Practice Address - Street 1:8379 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-2903
Practice Address - Country:US
Practice Address - Phone:810-224-9550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601120122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist