Provider Demographics
NPI:1538479142
Name:KING'S DENTAL & IMPLANT SERVICE LLC
Entity Type:Organization
Organization Name:KING'S DENTAL & IMPLANT SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:P
Authorized Official - Last Name:FITTON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-848-2400
Mailing Address - Street 1:555 N KING ST
Mailing Address - Street 2:STE. 111
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4658
Mailing Address - Country:US
Mailing Address - Phone:808-848-2400
Mailing Address - Fax:808-847-2238
Practice Address - Street 1:555 N KING ST
Practice Address - Street 2:STE. 111
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4658
Practice Address - Country:US
Practice Address - Phone:808-848-2400
Practice Address - Fax:808-847-2238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT24241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty