Provider Demographics
NPI:1548595630
Name:RYAN MAEHARA, DDS, INC.
Entity Type:Organization
Organization Name:RYAN MAEHARA, DDS, INC.
Other - Org Name:KAHALA DENTAL GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAEHARA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-734-3553
Mailing Address - Street 1:4211 WAIALAE AVE
Mailing Address - Street 2:SUITE # 109
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5319
Mailing Address - Country:US
Mailing Address - Phone:808-734-3553
Mailing Address - Fax:
Practice Address - Street 1:4211 WAIALAE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5319
Practice Address - Country:US
Practice Address - Phone:808-734-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-07
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-12101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty