Provider Demographics
NPI:1518012434
Name:UNIVERSITY OF HAWAII MAUI COMMUNITY COLLEGE
Entity Type:Organization
Organization Name:UNIVERSITY OF HAWAII MAUI COMMUNITY COLLEGE
Other - Org Name:MAUI ORAL HEALTH CENTER INITIATIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ALLIED HEALTH DEPARTMENT CHAIR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN APRN
Authorized Official - Phone:808-984-3250
Mailing Address - Street 1:310 KAAHUMANU AVE
Mailing Address - Street 2:ALLIED HEALTH DEPARTMENT MAUI COMMUNITY COLLEGE
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1644
Mailing Address - Country:US
Mailing Address - Phone:808-984-3250
Mailing Address - Fax:808-249-2175
Practice Address - Street 1:752 LOWER MAIN STREET
Practice Address - Street 2:MAUI ORAL HEALTH CENTER INITIATIVE
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1454
Practice Address - Country:US
Practice Address - Phone:808-244-4559
Practice Address - Fax:808-244-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI58924401Medicaid