Provider Demographics
NPI:1558505594
Name:KALAHEO DENTAL GROUP
Entity Type:Organization
Organization Name:KALAHEO DENTAL GROUP
Other - Org Name:TERRY R. ALLEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:ALEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-332-9445
Mailing Address - Street 1:2-2514 KAUMUALII HWY STE 204
Mailing Address - Street 2:
Mailing Address - City:KALAHEO
Mailing Address - State:HI
Mailing Address - Zip Code:96741-8304
Mailing Address - Country:US
Mailing Address - Phone:808-332-9445
Mailing Address - Fax:808-332-9632
Practice Address - Street 1:2-2514 KAUMUALII HWY STE 204
Practice Address - Street 2:
Practice Address - City:KALAHEO
Practice Address - State:HI
Practice Address - Zip Code:96741-8304
Practice Address - Country:US
Practice Address - Phone:808-332-9445
Practice Address - Fax:808-332-9632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI16321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty