Provider Demographics
NPI:1679699623
Name:KANEOHE DENTAL GROUP, INC.
Entity Type:Organization
Organization Name:KANEOHE DENTAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:TSUZAKI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-247-3343
Mailing Address - Street 1:45-880 KAMEHAMEHA HWY RM 101
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2969
Mailing Address - Country:US
Mailing Address - Phone:808-247-3343
Mailing Address - Fax:808-247-3343
Practice Address - Street 1:45-880 KAMEHAMEHA HWY RM 101
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-2969
Practice Address - Country:US
Practice Address - Phone:808-247-3343
Practice Address - Fax:808-247-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI15751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty