Provider Demographics
NPI:1720209166
Name:KYRIAKAKIS, NICHOLAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:KYRIAKAKIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1676 ALA MOANA BLVD
Mailing Address - Street 2:APARTMENT 510
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96815-1433
Mailing Address - Country:US
Mailing Address - Phone:808-941-4349
Mailing Address - Fax:
Practice Address - Street 1:1953 S BERETANIA ST
Practice Address - Street 2:SUITE 3A
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96826-1300
Practice Address - Country:US
Practice Address - Phone:808-791-0200
Practice Address - Fax:808-791-0201
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2070122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI54005603Medicaid