Provider Demographics
NPI:1558679373
Name:HAWAII DENTAL GROUP, INC.
Entity Type:Organization
Organization Name:HAWAII DENTAL GROUP, INC.
Other - Org Name:HAWAII FAMILY DENTAL CENTERS-WINDWARD MALL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KONDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-523-3103
Mailing Address - Street 1:500 ALA MOANA BLVD
Mailing Address - Street 2:SUITE 7-220
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-4920
Mailing Address - Country:US
Mailing Address - Phone:808-523-3103
Mailing Address - Fax:808-523-3122
Practice Address - Street 1:46-056 KAMEHAMEHA HWY
Practice Address - Street 2:SUITE 288
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3755
Practice Address - Country:US
Practice Address - Phone:808-235-2000
Practice Address - Fax:808-236-1050
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HAWAII DENTAL GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
No124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No126800000XDental ProvidersDental AssistantGroup - Multi-Specialty