Provider Demographics
NPI:1699004978
Name:KANEMARU DENTAL GROUP, INC
Entity Type:Organization
Organization Name:KANEMARU DENTAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:T
Authorized Official - Last Name:KANEMARU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-622-4354
Mailing Address - Street 1:410 KILANI AVE
Mailing Address - Street 2:SUITE #221
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1844
Mailing Address - Country:US
Mailing Address - Phone:808-622-4354
Mailing Address - Fax:808-622-0555
Practice Address - Street 1:410 KILANI AVE
Practice Address - Street 2:SUITE #221
Practice Address - City:WAHIAWA
Practice Address - State:HI
Practice Address - Zip Code:96786-1844
Practice Address - Country:US
Practice Address - Phone:808-622-4354
Practice Address - Fax:808-622-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI9641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty