Provider Demographics
NPI:1568606101
Name:ISLAND DENTAL, LLC
Entity Type:Organization
Organization Name:ISLAND DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-877-3000
Mailing Address - Street 1:444 HANA HWY STE 210
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2315
Mailing Address - Country:US
Mailing Address - Phone:808-877-3000
Mailing Address - Fax:
Practice Address - Street 1:444 HANA HWY STE 210
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2315
Practice Address - Country:US
Practice Address - Phone:808-877-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1485OtherSTATE OF HAWAII
HI1447463542OtherNPPES