Provider Demographics
NPI:1538302674
Name:KAPALAMA DENTAL CLINIC INC.
Entity Type:Organization
Organization Name:KAPALAMA DENTAL CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURICIO-MOLINA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-845-8855
Mailing Address - Street 1:675 N KING ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4526
Mailing Address - Country:US
Mailing Address - Phone:808-845-8855
Mailing Address - Fax:808-842-7739
Practice Address - Street 1:675 N KING ST STE 200
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4526
Practice Address - Country:US
Practice Address - Phone:808-845-8855
Practice Address - Fax:808-842-7739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI137801261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental