Provider Demographics
NPI:1801037585
Name:KONA 'OHANA DENTAL, INC.
Entity Type:Organization
Organization Name:KONA 'OHANA DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MURAMOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-329-6167
Mailing Address - Street 1:76-6225 KUAKINI HWY
Mailing Address - Street 2:SUITE B203
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3211
Mailing Address - Country:US
Mailing Address - Phone:808-629-6167
Mailing Address - Fax:808-334-0205
Practice Address - Street 1:76-6225 KUAKINI HWY
Practice Address - Street 2:SUITE B203
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3211
Practice Address - Country:US
Practice Address - Phone:808-629-6167
Practice Address - Fax:808-334-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-10
Last Update Date:2009-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT1584122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty