Provider Demographics
NPI:1558042150
Name:MAUNA KEA DENTAL LLC
Entity Type:Organization
Organization Name:MAUNA KEA DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TARVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-987-5770
Mailing Address - Street 1:65-1158 MAMALAHOA HWY STE 27A
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8442
Mailing Address - Country:US
Mailing Address - Phone:808-987-5770
Mailing Address - Fax:
Practice Address - Street 1:65-1158 MAMALAHOA HWY STE 27A
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8442
Practice Address - Country:US
Practice Address - Phone:808-987-5770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty