Provider Demographics
NPI:1598304198
Name:MALAMA DENTAL 4 KIDS, LLC
Entity Type:Organization
Organization Name:MALAMA DENTAL 4 KIDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMMON
Authorized Official - Middle Name:
Authorized Official - Last Name:KAU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-961-6704
Mailing Address - Street 1:275 PONAHAWAI ST STE 204
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3074
Mailing Address - Country:US
Mailing Address - Phone:808-961-6704
Mailing Address - Fax:808-935-1780
Practice Address - Street 1:275 PONAHAWAI ST STE 204
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3074
Practice Address - Country:US
Practice Address - Phone:808-961-6704
Practice Address - Fax:808-935-1780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty