Provider Demographics
NPI:1689045379
Name:ALOHA FAMILY DENTAL LLC
Entity Type:Organization
Organization Name:ALOHA FAMILY DENTAL LLC
Other - Org Name:KAHULUI DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACE
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-871-6337
Mailing Address - Street 1:33 LONO AVE STE 370
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-1636
Mailing Address - Country:US
Mailing Address - Phone:808-871-6337
Mailing Address - Fax:
Practice Address - Street 1:33 LONO AVE STE 370
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1636
Practice Address - Country:US
Practice Address - Phone:808-871-6337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT42921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty