Provider Demographics
NPI:1801208178
Name:HAWAII DENTAL CLINIC LANAI
Entity Type:Organization
Organization Name:HAWAII DENTAL CLINIC LANAI
Other - Org Name:HAWAII DENTAL CLINIC LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:WH
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-538-6522
Mailing Address - Street 1:50 S BERETANIA ST STE C117B
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2287
Mailing Address - Country:US
Mailing Address - Phone:808-538-6522
Mailing Address - Fax:
Practice Address - Street 1:730 LANAI AVENUE #101
Practice Address - Street 2:
Practice Address - City:LANAI CITY
Practice Address - State:HI
Practice Address - Zip Code:96763
Practice Address - Country:US
Practice Address - Phone:808-565-6418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty